Top

Published in:

Open Access 07-12-2023 | Endometriosis | Review Article

Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis

Authors: Ádám Csirzó, Dénes Péter Kovács, Anett Szabó, Péter Fehérvári, Árpád Jankó, Péter Hegyi, Péter Nyirády, Zoltán Sipos, Levente Sára, Nándor Ács, István Szabó, Sándor Valent

Published in: Surgical Endoscopy | Issue 2/2024

Abstract

Background

Endometriosis is a chronic condition affecting 6–10% of women of reproductive age, with endometriosis-related pain and infertility being the leading symptoms. Currently, the gold standard treatment approach to surgery is conventional laparoscopy (CL); however, the increasing availability of robot-assisted surgery is projected as a competitor of CL. This study aimed to compare the perioperative outcomes of robot-assisted laparoscopy (RAL) and CL in endometriosis surgery.

Objectives

We aimed to compare the effectiveness and safety of these two procedures.

Methods

A systematic search was conducted in three medical databases. Studies investigating different perioperative outcomes of endometriosis-related surgeries were included. Results are presented as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI).

Results

Our search yielded 2,014 records, of which 13 were eligible for data extraction. No significant differences were detected between the CL and RAL groups in terms of intraoperative complications (OR = 1.07, CI 0.43–2.63), postoperative complications (OR = 1.3, CI 0.73–2.32), number of conversions to open surgery (OR = 1.34, CI 0.76–2.37), length of hospital stays (MD = 0.12, CI 0.33–0.57), blood loss (MD = 16.73, CI 4.18–37.63) or number of rehospitalizations (OR = 0.95, CI 0.13–6.75). In terms of operative times (MD = 28.09 min, CI 11.59–44.59) and operating room times (MD = 51.39 min, CI 15.07–87.72;), the RAL technique remained inferior.

Conclusion

RAL does not have statistically demonstrable advantages over CL in terms of perioperative outcomes for endometriosis-related surgery.

Graphical abstract

Available only for authorised users

González-Mesa E, Moya-Bejarano D, Butrón-Hinojo CA, Marín-Sánchez P, Blasco-Alonso M, Jimenez-López JS, Villegas-Muñoz E, Lubián-López DM (2021) Correlates of sexual function in a sample of Spanish women with endometriosis. J Clin Med 10(21):4957. https://doi.org/10.3390/jcm10214957CrossRefPubMedPubMedCentral

Bulun SE, Yilmaz BD, Sison C, Miyazaki K, Bernardi L, Liu S, Kohlmeier A, Yin P, Milad M, Wei J (2019) Endometriosis. Endocr Rev 40(4):1048–1079. https://doi.org/10.1210/er.2018-00242CrossRefPubMedPubMedCentral

Samy A, Taher A, Sileem SA, Abdelhakim AM, Fathi M, Haggag H, Ashour K, Ahmed SA, Shareef MA, AlAmodi AA, Keshta NHA, Shatat HBAE, Salah DM, Ali AS, El Kattan EAM, Elsherbini M (2021) Medical therapy options for endometriosis related pain, which is better? A systematic review and network meta-analysis of randomized controlled trials. J Gynecol Obstet Hum Reprod. 50(1):101798. https://doi.org/10.1016/j.jogoh.2020.101798CrossRefPubMed

Mikhail E, Pavlovic ZJ, Al Jumaily M, Kheil MH, Moawad GN, Soares T (2022) Robot-assisted surgery for endometriosis current and future perspectives. Surg Technol Int 19(40):197–202. https://doi.org/10.52198/22.STI.40.GY1562CrossRef

Safiejko K, Tarkowski R, Koselak M, Juchimiuk M, Tarasik A, Pruc M, Smereka J, Szarpak L (2021) Robotic-assisted vs. standard laparoscopic surgery for rectal cancer resection: a systematic review and meta-analysis of 19,731 patients. Cancers 14(1):180. https://doi.org/10.3390/cancers14010180CrossRefPubMedPubMedCentral

Guerrini GP, Lauretta A, Belluco C, Olivieri M, Forlin M, Basso S, Breda B, Bertola G, Di Benedetto F (2017) Robotic versus laparoscopic distal pancreatectomy: an up-to-date meta-analysis. BMC Surg 17(1):105. https://doi.org/10.1186/s12893-017-0301-3CrossRefPubMedPubMedCentral

Varghese A, Doglioli M, Fader AN (2019) Updates and controversies of robotic-assisted surgery in gynecologic surgery. Clin Obstet Gynecol 62(4):733–748. https://doi.org/10.1097/GRF.0000000000000489CrossRefPubMedPubMedCentral

Chandler J, Hopewell S (2013) Cochrane methods–twenty years experience in developing systematic review methods. Syst Rev 20(2):76. https://doi.org/10.1186/2046-4053-2-76CrossRef

McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 22(3):276–282CrossRefPubMedPubMedCentral

10.

McGuinness LA, Higgins JPT (2021) Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 12(1):55–61. https://doi.org/10.1002/jrsm.1411CrossRefPubMed

11.

GRADEpro GDT (2023) GRADEpro Guideline Development Tool [Software]. McMaster University and Evidence Prime. Available from www.gradepro.org/

12.

IntHout J, Ioannidis JP, Borm GF (2014) The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol 18(14):25. https://doi.org/10.1186/1471-2288-14-25CrossRef

13.

Harrer M, Cuijpers P, Furukawa T, Ebert D (2021) Doing meta-analysis with R: a hands-on guide. Chapman and Hall/CRC, Boca Raton. https://doi.org/10.1201/9781003107347CrossRef

14.

Viechtbauer W, Cheung MW (2010) Outlier and influence diagnostics for meta-analysis. Res Synth Methods 1(2):112–125. https://doi.org/10.1002/jrsm.11CrossRefPubMed

15.

IntHout J, Ioannidis JP, Rovers MM, Goeman JJ (2016) Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open 6(7):e010247. https://doi.org/10.1136/bmjopen-2015-010247CrossRefPubMedPubMedCentral

16.

R Core Team (2021) R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. https://www.R-project.org/

17.

Schwarzer G (2022) Meta: general package for meta-analysis. https://github.com/guido-s/meta/. https://doi.org/10.1007/978-3-319-21416-0

18.

Cuijpers P, Furukawa T, Ebert DD (2021) Dmetar: companion R Package for the guide doing meta-analysis in R. https://dmetar.protectlab.org

19.

Moon HS, Shim JE, Lee SR, Jeong K (2018) The comparison of robotic single-site surgery to single-port laparoendoscopic surgery for the treatment of advanced-stage endometriosis. J Laparoendosc Adv Surg Tech A 28(12):1483–1488. https://doi.org/10.1089/lap.2018.0118CrossRefPubMed

20.

Lee HJ, Lee JS, Lee YS (2020) Comparison of serum antimüllerian hormone levels after robotic-assisted vs. laparoscopic approach for ovarian cystectomy in endometrioma. Eur J Obstet Gynecol Reprod Biol 249:9–13. https://doi.org/10.1016/j.ejogrb.2020.04.010CrossRefPubMed

21.

Raimondo D, Alboni C, Orsini B, Aru AC, Farulla A, Maletta M, Arena A, Del Forno S, Sampogna V, Mastronardi M, Petrillo M, Seracchioli R (2021) Comparison of perioperative outcomes between standard laparoscopic and robot-assisted approach in patients with rectosigmoid endometriosis. Acta Obstet Gynecol Scand 100(9):1740–1746. https://doi.org/10.1111/aogs.14170CrossRefPubMed

22.

Le Gac M, Ferrier C, Touboul C, Owen C, Arfi A, Boudy AS, Jayot A, Bendifallah S, Daraï E (2020) Comparison of robotic versus conventional laparoscopy for the treatment of colorectal endometriosis: pilot study of an expert center. J Gynecol Obstet Hum Reprod. https://doi.org/10.1016/j.jogoh.2020.101885CrossRefPubMed

23.

Nezhat CR, Stevens A, Balassiano E, Soliemannjad R (2015) Robotic-assisted laparoscopy vs conventional laparoscopy for the treatment of advanced stage endometriosis. J Minim Invasive Gynecol 22(1):40–44. https://doi.org/10.1016/j.jmig.2014.06.002CrossRefPubMed

24.

Magrina JF, Espada M, Kho RM, Cetta R, Chang YH, Magtibay PM (2015) Surgical excision of advanced endometriosis: perioperative outcomes and impacting factors. J Minim Invasive Gynecol 22(6):944–950. https://doi.org/10.1016/j.jmig.2015.04.016CrossRefPubMed

25.

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. https://doi.org/10.4293/JSLS.2014.00094CrossRefPubMedPubMedCentral

26.

Soto E, Luu TH, Liu X, Magrina JF, Wasson MN, Einarsson JI, Cohen SL, Falcone T (2017) Laparoscopy vs. robotic surgery for endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril 107(4):996–1002. https://doi.org/10.1016/j.fertnstert.2016.12.033CrossRefPubMed

27.

Chen SH, Li ZA, Du XP (2016) Robot-assisted versus conventional laparoscopic surgery in the treatment of advanced stage endometriosis: a meta-analysis. Clin Exp Obstet Gynecol 43(3):422–426CrossRefPubMed

28.

Restaino S, Mereu L, Finelli A, Spina MR, Marini G, Catena U, Turco LC, Moroni R, Milani M, Cela V, Scambia G, Fanfani F (2020) Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robot Surg 14(5):687–694. https://doi.org/10.1007/s11701-020-01061-yCrossRefPubMed

29.

Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P (2018) Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 33(7):835–847. https://doi.org/10.1007/s00384-018-3082-y. Erratum in: Int J Colorectal Dis. 2018 Jul 9CrossRefPubMed

30.

Feng Z, Feng MP, Feng DP, Solórzano CC (2020) Robotic-assisted adrenalectomy using da Vinci Xi vs Si: are there differences? J Robot Surg 14(2):349–355. https://doi.org/10.1007/s11701-019-00995-2CrossRefPubMed

31.

Hiltunen J, Eloranta ML, Lindgren A, Keski-Nisula L, Anttila M, Sallinen H (2021) Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area. J Int Med Res 49(8):3000605211032788. https://doi.org/10.1177/03000605211032788CrossRefPubMed

32.

Le Carpentier M, Merlot B, Bot Robin V, Rubod C, Collinet P (2016) Étude comparative : laparoscopie robot assistée versus cœlioscopie chez les patientes avec une endométriose vésicale [Partial cystectomy for bladder endometriosis: Robotic assisted laparoscopy versus standard laparoscopy]. Gynecol Obstet Fertil 44(6):315–321. https://doi.org/10.1016/j.gyobfe.2016.02.006. (French)CrossRefPubMed

33.

Marino P, Houvenaeghel G, Narducci F, Boyer-Chammard A, Ferron G, Uzan C, Bats AS, Mathevet P, Dessogne P, Guyon F, Rouanet P, Jaffre I, Carcopino X, Perez T, Lambaudie E (2015) Cost-effectiveness of conventional vs robotic-assisted laparoscopy in gynecologic oncologic indications. Int J Gynecol Cancer 25(6):1102–1108. https://doi.org/10.1097/IGC.0000000000000458CrossRefPubMed

34.

Lee YJ, Lee DE, Oh HR, Ha HI, Lim MC (2022) Learning curve analysis of multiport robot-assisted hysterectomy. Arch Gynecol Obstet 306(5):1555–1561. https://doi.org/10.1007/s00404-022-06655-5CrossRefPubMed

35.

Terzi H, Biler A, Demirtas O, Guler OT, Peker N, Kale A (2016) Total laparoscopic hysterectomy: analysis of the surgical learning curve in benign conditions. Int J Surg 35:51–57. https://doi.org/10.1016/j.ijsu.2016.09.010CrossRefPubMed

36.

Shugaba A, Lambert JE, Bampouras TM, Nuttall HE, Gaffney CJ, Subar DA (2022) Should all minimal access surgery be robot-assisted? A systematic review into the musculoskeletal and cognitive demands of laparoscopic and robot-assisted laparoscopic surgery. J Gastrointest Surg 26(7):1520–1530. https://doi.org/10.1007/s11605-022-05319-8CrossRefPubMedPubMedCentral

37.

Sers R, Forrester S, Zecca M, Ward S, Moss E (2021) The ergonomic impact of patient body mass index on surgeon posture during simulated laparoscopy. Appl Ergon 97:103501. https://doi.org/10.1016/j.apergo.2021.103501CrossRefPubMed

38.

AAGL Advancing Minimally Invasive Gynecology Worldwide (2013) AAGL position statement: robotic-assisted laparoscopic surgery in benign gynecology. J Minim Invasive Gynecol 20(1):2–9. https://doi.org/10.1016/j.jmig.2012.12.007CrossRef

39.

Sloth SB, Schroll JB, Settnes A, Gimbel H, Rudnicki M, Topsoee MF, Joergensen A, Nortvig H, Moeller C (2017) Systematic review of the limited evidence for different surgical techniques at benign hysterectomy: a clinical guideline initiated by the Danish Health Authority. Eur J Obstet Gynecol Reprod Biol 216:169–177. https://doi.org/10.1016/j.ejogrb.2017.07.012CrossRefPubMed

40.

Ballester M, Roman H (2018) Prise en charge chirurgicale de l’endométriose profonde avec atteinte digestive, RPC Endométriose CNGOF-HAS [Surgical management of deep endometriosis with colorectal involvement: CNGOF-HAS Endometriosis Guidelines]. Gynecol Obstet Fertil Senol. 46(3):290–295. https://doi.org/10.1016/j.gofs.2018.02.003. (French)CrossRefPubMed

41.

Hegyi P, Erőss B, Izbéki F, Párniczky A, Szentesi A (2021) Accelerating the translational medicine cycle: the Academia Europaea pilot. Nat Med 27(8):1317–1319. https://doi.org/10.1038/s41591-021-01458-8CrossRefPubMed

42.

Hegyi P, Petersen OH, Holgate S, Erőss B, Garami A, Szakács Z, Dobszai D, Balaskó M, Kemény L, Peng S, Monteiro J, Varró A, Lamont T, Laurence J, Gray Z, Pickles A, FitzGerald GA, Griffiths CEM, Jassem J, Rusakov DA, Verkhratsky A, Szentesi A (2020) Academia Europaea position paper on translational medicine: the cycle model for translating scientific results into community benefits. J Clin Med 9(5):1532. https://doi.org/10.3390/jcm9051532CrossRefPubMedPubMedCentral

43.

Ferrier C, Le Gac M, Kolanska K, Boudy AS, Dabi Y, Touboul C, Bendifallah S, Daraï E (2022) Comparison of robot-assisted and conventional laparoscopy for colorectal surgery for endometriosis: a prospective cohort study. Int J Med Robot. 18(3):e2382. https://doi.org/10.1002/rcs.2382CrossRefPubMed

44.

Dulemba JF, Pelzel C, Hubert HB (2013) Retrospective analysis of robot-assisted versus standard laparoscopy in the treatment of pelvic pain indicative of endometriosis. J Robot Surg 7(2):163–169. https://doi.org/10.1007/s11701-012-0361-4CrossRefPubMed

45.

Nezhat C, Lewis M, Kotikela S, Veeraswamy A, Saadat L, Hajhosseini B, Nezhat C (2010) Robotic versus standard laparoscopy for the treatment of endometriosis. Fertil Steril 94(7):2758–2760. https://doi.org/10.1016/j.fertnstert.2010.04.031CrossRefPubMed

Title: Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis
Authors: Ádám Csirzó
Dénes Péter Kovács
Anett Szabó
Péter Fehérvári
Árpád Jankó
Péter Hegyi
Péter Nyirády
Zoltán Sipos
Levente Sára
Nándor Ács
István Szabó
Sándor Valent
Publication date: 07-12-2023
Publisher: Springer US
Keywords: Endometriosis
Laparoscopy
Published in: Surgical Endoscopy / Issue 2/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10587-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis

Abstract

Background

Objectives

Methods

Results

Conclusion

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusion

Graphical abstract

Please log in to get access to this content

Other articles of this Issue 2/2024

Kinematic metrics and surgeon experience in robotic cholecystectomies: a pilot study on breaking down technical performance

Association of time to resection with survival in patients with colon cancer

Comparison of clinical outcome between laparoscopic and open hepatectomy of high difficulty score for hepatocellular carcinoma: a propensity score analysis

Flying endoscopists in the Arctic: initiatives for quality assurance of endoscopies in Greenland

Outcomes after per-oral endoscopic myotomy for Zenker’s diverticula (Z-POEM) and correlation with impedance planimetry (FLIP)

Robotic approach for retromuscular ventral hernia repair may be associated with improved wound morbidity in high-risk patients: a propensity score analysis