Comparison of surgical outcomes between robot-assisted and conventional laparoscopic hysterectomy for stage IV endometriosis: A propensity score-matched analysis and review of the literature.

Minimally invasive surgery, especially laparoscopic surgery, remains the standard treatment for endometriosis; however, robotic-assisted surgery (RAS) is also gaining adoption. Several meta-analyses have reported comparable perioperative outcomes between RAS and conventional laparoscopy. This retrospective cohort study aimed to compare the surgical outcomes between RAS and conventional laparoscopic surgery (CLS) for hysterectomy in patients with severe endometriosis. Among 2,466 minimally invasive hysterectomies performed for benign gynecologic diseases between October 2021 and December 2024, 223 patients with severe endometriosis (revised American Society for Reproductive Medicine [rASRM] stage IV) were identified. After excluding cases requiring concomitant gastrointestinal or urologic procedures, 154 patients were included (RAS, n = 86; CLS, n = 68). Propensity score matching (1:1) was performed using covariates including rASRM score, ENZIAN classification, body mass index, prior abdominal surgery, and uterine weight. After matching, 96 patients were analyzed (48 per group). Operative time, estimated blood loss, and postoperative hemoglobin change were 97 vs. 110 min (p = 0.179), 50 vs. 100 mL (p = 0.002), and ˗1.2 vs. ˗1.1 g/dL (p = 0.605) in the RAS and CLS groups, respectively. Intraoperative complication rates were 0% vs. 2.1% (p = 1.000), and postoperative complication rates were identical at 8.3% in both groups (p = 1.000). RAS hysterectomy in patients with severe endometriosis was associated with significantly lower blood loss and comparable operative time compared with CLS, with no differences in perioperative complications. These findings suggest a potential advantage of RAS; however, further studies are warranted.