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Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis

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Abstract

Endometriosis is one of the most common medical conditions affecting the women. The study aimed to evaluate the safety and efficacy of robotic-assisted laparoscopic surgery (RAS) versus conventional laparoscopic surgery (LPS) in the treatment of endometriosis. PubMed, Embase, Cochrane and CINAHL databases were searched from January 1995 to March 2019. According to meta-analysis criteria, five comparative studies were selected. A total of 1527 patients were identified. In the meta-analysis, there were no significant differences in blood loss, complication, and hospital stay between RAS and LPS surgeries in the treatment of patients with endometriosis. However, RAS surgery required a higher weighted mean operating time than LPS surgery, 0.54 (95% confidence interval; 0.37 to 0.70; p < 0.00001) min. This meta-analysis confirmed that the robotic surgery is safe and feasible in patients affected by endometriosis. We could suggest that RAS is a valid option and might be considered an alternative to LPS especially in advanced cases.

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References

  1. Giudice LC (2010) Clinical practice. Endometriosis. N Engl J Med 362:2389–2398

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. (2010) Practice bulletin no. 114: management of endometriosis. Obstet Gynecol 116(1):223–236. https://doi.org/10.1097/AOG.0b013e3181e8b073

  3. Kho RM, Andres MP, Borrelli GM et al (2018) Surgical treatment of different types of endometriosis: comparison of major society guidelines and preferred clinical algorithms. Best Pract Res Clin Obstet Gynaecol 51:102–110

    Article  PubMed  Google Scholar 

  4. Dunselman GA, Vermeulen N, Becker C et al (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod Oxf Engl 29:400–412

    Article  CAS  Google Scholar 

  5. Practice Committee of the American Society for Reproductive Medicine (2012) Endometriosis and infertility: a committee opinion. Fertil Steril 98:591–598

    Article  Google Scholar 

  6. Leyland N, Casper R, Laberge P et al (2010) Endometriosis: diagnosis and management. J Obstet Gynaecol Can 32:S1–S3

    Article  PubMed  Google Scholar 

  7. de Paula Andres M, Borrelli GM, Kho RM et al (2017) The current management of deep endometriosis: a systematic review. Minerva Ginecol 69:587–596

    PubMed  Google Scholar 

  8. Nisolle M, Donnez J (1997) Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 68:585–596

    Article  CAS  PubMed  Google Scholar 

  9. Cornillie FJ, Oosterlynck D, Lauweryns JM et al (1990) Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril 53:978–983

    Article  CAS  PubMed  Google Scholar 

  10. Angioni S, Peiretti M, Zirone M et al (2006) Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without rectum involvement: surgical treatment and long-term follow-up. Hum Reprod Oxf Engl 21:1629–1634

    Article  CAS  Google Scholar 

  11. Berlanda N, Frattaruolo MP, Aimi G et al (2017) Money for nothing. The role of robotic-assisted laparoscopy for the treatment of endometriosis. Reprod Biomed Online 35(4):435–444

    Article  PubMed  Google Scholar 

  12. Luu TH, Uy-Kroh MJ (2017) New developments in surgery for endometriosis and pelvic pain. Clin Obstet Gynecol 60:245–251

    Article  PubMed  Google Scholar 

  13. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    Article  PubMed  Google Scholar 

  14. Zorzela L, Loke YK, Ioannidis JP et al (2016) PRISMA harms checklist: improving harms reporting in systematic reviews. BMJ 352:i157

    Article  PubMed  Google Scholar 

  15. Dubeshter B, Angel C, Toy E et al (2013) Current role of robotic hysterectomy. J Gynecol Surg 29(4):174–178

    Article  PubMed  PubMed Central  Google Scholar 

  16. Nezhat C, Lewis M, Kotikela S et al (2010) Robotic versus standard laparoscopy for the treatment of endometriosis. Fertil Steril 94(7):2758–2760

    Article  PubMed  Google Scholar 

  17. Nezhat FR, Sirota I (2014) Perioperative outcomes of robotic assisted laparoscopic surgery versus conventional laparoscopy surgery for advanced-stage endometriosis. JSLS. 18(4):e2014.00094

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nezhat CR, Stevens A, Balassiano E et al (2015) Robotic-assisted laparoscopy vs conventional laparoscopy for the treatment of advanced stage endometriosis. J Minim Invasive Gynecol 22(1):40–44

    Article  PubMed  Google Scholar 

  19. Soto E, Luu TH, Liu X et al (2017) Laparoscopy vs robotic surgery for endometriosis (LAROSE):a multicenter, randomized, controlled trial. Fertil Steril 107(4):996–1002.e3

    Article  PubMed  Google Scholar 

  20. Magrina JF, Espada M, Kho RM et al (2015) Surgical excision of advanced endometriosis: perioperative outcomes and impacting factors. J Minim Invasive Gynecol 22(6):944–950

    Article  PubMed  Google Scholar 

  21. Lawrie TA, Liu H, Lu D et al (2019) Robot-assisted surgery in gynaecology. Cochrane Database Syst Rev 4:CD011422

    PubMed  Google Scholar 

  22. Ercoli A, Bassi E, Ferrari S et al (2017) Robotic-assisted conservative excision of retrocervical-rectal deep infiltrating endometriosis: a case series. J Minim Invasive Gynecol. 24(5):863–868

    Article  PubMed  Google Scholar 

  23. Chen Y, Wang H, Wang S et al (2019) Efficacy of ten interventions for endometriosis: a network meta-analysis. J Cell Biochem 120(8):13076–13084

    Article  CAS  PubMed  Google Scholar 

  24. Nagendran M, Gurusamy KS, Aggarwal R et al (2013) Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 27(8):CD006575

    Google Scholar 

  25. Luu TH, Uy-Kroh MJ (2017) New developments in surgery for endometriosis and pelvic pain. Clin Obstet Gynecol 60(2):245–251

    Article  PubMed  Google Scholar 

  26. Fanfani F, Restaino S, Ercoli A et al (2016) Robotic versus laparoscopic surgery in gynecology: which should we use? Minerva Ginecol 68(4):423–430

    PubMed  Google Scholar 

  27. Siesto G, Ieda N, Rosati R et al (2014) Robotic surgery for deep endometriosis: a paradigm shift. Int J Med Robot. 10(2):140–146

    Article  PubMed  Google Scholar 

  28. Vercellini P (1997) Endometriosis: what a pain it is. Semin Reprod Endocrinol. 15(3):251–261

    Article  CAS  PubMed  Google Scholar 

  29. Cassini D, Cerullo G, Miccini M et al (2014) Robotic hybrid technique in rectal surgery for deep pelvic endometriosis. Surg. Innov. 21:52–58

    Article  PubMed  Google Scholar 

  30. Turchetti G, Pierotti F, Palla I et al (2017) Comparative health technology assessment of robotic assisted, direct manual laparoscopic and open surgery: a prospective study. Surg Endosc 31(2):543–551

    Article  PubMed  Google Scholar 

  31. Duffy JM, Arambage K, Correa FJ et al (2014) Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev. 4:CD011031

    Google Scholar 

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Authors and Affiliations

  1. Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento per la Tutela della Salute della Donna e della Vita Nascente, L.go A. Gemelli, 00167, Rome, Italy

    Stefano Restaino, Ursula Catena, Giovanni Scambia & Francesco Fanfani

  2. Department of Obstetrics and Gynecology, Santa Chiara Hospital, Largo Medaglie d’Oro 9, 38121, Trento, Italy

    Liliana Mereu

  3. Department of Medicine and Aging Sciences University “G. d’Annunzio” of Chieti-Pescara, Via dei Vestini 131, 66100, Chieti, CH, Italy

    Angelo Finelli, Maria Roberta Spina, Giulia Marini & Michela Milani

  4. Division of Gynecologic Oncology, Fondazione di ricercar e cura Giovanni Paolo II, Chatolic University of Sacred Heart, Campobasso, CB, Italy

    Luigi Carlo Turco

  5. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Rossana Moroni

  6. Biostatistico Presso Direzione Scientifica, Rome, Italy

    Rossana Moroni

  7. Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy

    Vito Cela

  8. Università Cattolica del Sacro Cuore, Rome, Italy

    Giovanni Scambia & Francesco Fanfani

  9. Division of Gynecological Oncology, Department of Obstetric and Gynecology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli, 00167, Rome, RM, Italy

    Stefano Restaino

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  1. Stefano Restaino
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  2. Liliana Mereu
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Correspondence to Stefano Restaino.

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Conflict of interest

Author Stefano Restaino, Author Liliana Mereu, Author Angelo Finelli, Author Maria Roberta Spina, Author Giulia Marini, Author Ursula Catena, Author Luigi Carlo Turco, Author Rossana Moroni, Author Michela Milani, Author Vito Cela, Author Giovanni Scambia and Author Francesco Fanfani declare that they have no conflict of interest.

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Restaino, S., Mereu, L., Finelli, A. et al. Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robotic Surg 14, 687–694 (2020). https://doi.org/10.1007/s11701-020-01061-y

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  • DOI: https://doi.org/10.1007/s11701-020-01061-y

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