Comparison of perioperative outcomes between robotic surgery and traditional laparoscopy for colorectal endometriosis: a systematic review and meta-analysis.

Robotic-assisted surgery (RAS) offers a broader surgical field, enhanced visualization, and greater instrument maneuverability, suggesting potential advantages over traditional laparoscopic surgery (LPS), which is currently the gold standard for treating colorectal endometriosis. To address this gap, we conducted a comprehensive review of existing studies to compare the perioperative outcomes of RAS and LPS in the management of colorectal endometriosis. A comprehensive search was conducted in the databases of PubMed, Web of Science, the Cochrane Library, and SpringerLink to identify any studies that prior to February 2nd, 2025. To compare RAS to LPS for colorectal endometriosis, we looked at things like operation duration, expected blood loss, length of stay, conversion to laparotomy, all complications, and bowel endometriosis resection. The operative time for RAS in colorectal endometriosis resection was significantly longer than that for LPS (data aggregated from six studies; WMD 21.51 min, 95% CI 4.58-38.43, p < 0.05). However, there were no significant differences between the two groups in intraoperative blood loss (four studies; WMD 1.2 ml, 95% CI - 34.01-36.41, p = 0.95), length of hospital stay (four studies; WMD 0.2 days, 95% CI - 1.09-1.49, p = 0.76), or the number of cases requiring conversion to laparotomy (four studies; OR 2.27, 95% CI 0.52-9.95, p = 0.28) (Fig. 2). LPS demonstrated a significantly higher utilization of segmental resection (six studies; OR 0.71, 95% CI 0.54-0.93, p < 0.05), while no significant differences were observed in the rates of shaving (six studies; OR 1.06, 95% CI 0.77-1.47, p = 0.71) or double discoid excision (six studies; OR 1.3, 95% CI 0.95-1.78, p = 0.1) (Fig. 3). Additionally, the included studies reported no significant differences in overall complication rates (five studies; OR 0.9, 95% CI 0.64-1.28, p = 0.57) (Fig. 3) or the incidence of Clavien-Dindo classification complications classified as Grade I(five studies; OR 0.85, 95% CI 0.44-1.65, p = 0.64), II(five studies; OR 0.59, 95% CI 0.35-1.0, p = 0.5), III(five studies; OR 1.12, 95% CI 0.63-2.0, p = 0.7), or IV(five studies; OR 0.8, 95% CI 0.14-4.59, p = 0.81). Our study found that, apart from a significantly longer operative time for RAS compared to LPS, RAS demonstrated comparable outcomes in intraoperative blood loss, length of hospital stay, conversion to open surgery, bowel endometriosis resection, and postoperative complication rates. These findings suggest that RAS has the potential to become a viable alternative to LPS in the future. However, this conclusion still requires validation through large-scale, prospective, randomized controlled trials.