Robotic versus laparoscopic colectomy for deep infiltrative endometriosis of the bowel: a propensity-matched analysis of US-based hospitals.

Deep infiltrative endometriosis involving the bowel is a complex disease in which the optimal minimally invasive surgical approach remains uncertain, particularly regarding long-term fertility, recurrence, and healthcare utilization. We conducted a retrospective propensity score-matched cohort study using the TriNetX US Collaborative Network, including 72 healthcare organizations. Adult women who underwent minimally invasive colectomy for colorectal endometriosis between October 2013 and October 2025 were identified. Patients with prior hysterectomy, malignancy, inflammatory bowel disease, adenomyosis, or conversion to open surgery were excluded. Robotic colectomy was compared with conventional laparoscopic colectomy. After 1:1 propensity score matching, 487 patients were included in each cohort, with balanced baseline characteristics. At 3 years, robotic colectomy was associated with higher pregnancy achievement compared with laparoscopy (7.2% vs 2.9%; RR 2.50, 95% CI 1.36-4.59), lower endometriosis recurrence (4.3% vs 20.1%; RR 0.21, 95% CI 0.14-0.34), and reduced long-term opioid utilization (68.4% vs 89.3%; RR 0.77, 95% CI 0.72-0.82). At 5 years, these benefits persisted, with higher pregnancy achievement (7.8% vs 3.3%), lower recurrence (4.7% vs 18.5%), reduced opioid utilization (68.0% vs 90.3%), and fewer emergency readmissions (26.7% vs 35.1%). No significant differences were observed in urinary dysfunction, urinary incontinence, pelvic or perineal pain, dysmenorrhea, or dyspareunia. In this propensity-matched analysis, robotic colectomy was associated with higher recorded pregnancy and lower recurrence, opioid use, and readmission; given shorter follow-up and no fertility-intent data, these associations are hypothesis-generating.