Visualization of endometriosis: comparative study of 3-dimensional robotic and 2-dimensional laparoscopic endoscopes
The main objective of this study was to compare results of using the robotic 3D/HD scope and the 2D/HD laparoscope for visual detection of histologically confirmed endometriosis. Three surgeons from different practices enrolled premenopausal women ≥18 years who had elected to undergo robotic-assisted endometriosis resection. Patients were randomized to receive 2D/HD laparoscopic visualization either before or after 3D/HD robotic visualization. Resections then proceeded robotically. The number of histologically confirmed lesions overall and by abdomino-pelvic location, appearance and size was compared by scope type used. During the study, 598 lesions were visualized in 98 patients. Average number of lesions per patient using either scope was 6.1. Mean age was 31 years and 77% were disease stage I/II. On histopathology, 58.4% of lesions resected were consistent with endometriosis. All (100%) of these lesions were detected using the robotic 3D/HD scope and 77.9% using the 2D/HD laparoscope (p < 0.001). Compared to laparoscopic, robotic visualization resulted in detection of more confirmed lesions in all anatomic locations and for most appearances, including the cul-de-sac (100 vs. 79%), atypical appearance (100 vs. 71.3%) and width <5 mm (100 vs. 62%), p’s < 0.001). Logistic regression indicated that use of the 3D/HD robotic scope was independently associated with 2.36 times the likelihood (95% CI 1.20, 4.66; p = 0.014) of detecting a confirmed lesion, compared to the 2D/HD laparoscope. Large-scale, long-term studies are needed to substantiate these findings in multiple practice settings and to determine whether 3D robotic versus 2D laparoscopic resection has a beneficial impact on symptomatology, recurrence and fertility outcomes.
KeywordsRobotic surgery Laparoscopic surgery Endometriosis Pelvic pain Histology
The authors wish to acknowledge Shilpa Mehendale, MS, MBA and Ali Andreasen, MD, of Intuitive Surgical, Bharathi Lingala, PhD, Stanford University and Helen Hubert, PhD, Consulting Epidemiologist for their support during study execution, analysis and manuscript preparation.
Compliance with ethical standards
Conflict of interest
Cindy Mosbrucker, MD is a Proctor at Intuitive Surgical, Inc. Anita Somani, MD and John Dulemba, MD were formerly Proctors at Intuitive Surgical, Inc.
This study was sponsored and funded by Intuitive Surgical Inc., Sunnyvale, CA, USA in association with the study investigators (co-authors) under a cooperative clinical trial agreement. The authors had full control of the study execution, analysis and development of the manuscript.
Research involving human participants
All procedures performed in these studies were approved by the Institutional Review Board at each site and were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Burney RO, Giudice LC (2013) The pathogenesis of endometriosis. In: Nezhat C, Nezhat F, Nezhat C (eds) Nezhat’s video-assisted and robotic-assisted laparoscopy and hysteroscopy, 4th edn. Cambridge University Press, Cambridge, England, pp 252–259Google Scholar
- 20.Albee RB, Sinervo K, Fisher DT (2008) Laparoscopic excision of lesions suggestive of endometriosis or otherwise atypical in appearance: relationship between visual findings and final histologic diagnosis. J Minim Invasive Gynecol 15(1):32–37. doi: 10.1016/j.jmig.2007.08.619 CrossRefPubMedGoogle Scholar