Comparison of perioperative outcomes between laparoscopy and robotic-assisted surgery in the surgical treatment of endometriosis: a retrospective study.

Minimally invasive surgery is the gold standard for the surgical treatment of endometriosis. However, controversy remains in the literature regarding the perioperative benefits of robotic-assisted surgery compared to laparoscopic surgery, particularly regarding operative efficiency. To compare perioperative outcomes between laparoscopy and robotic-assisted surgery in the surgical treatment of endometriosis in a high-volume tertiary center. Retrospective, observational, and analytical study including patients who underwent minimally invasive surgery for the treatment of endometriosis at Einstein Hospital Israelita between 2018 and 2022. A random sample of 520 patients was drawn from all eligible medical records in the period, with 260 patients in each surgical group; the surgical approach was determined by surgeon preference rather than a standardized protocol. Outcomes evaluated included surgical time, anesthetic time, length of hospital stay, estimated blood loss, intraoperative complications, need for intensive care, conversion to laparotomy, and early readmission. Demographic characteristics were similar between the groups, although the two groups differed in prior surgical history. Robotic-assisted surgery was associated with significantly shorter operative and anesthetic times, in addition to shorter hospital stays, when compared to laparoscopic surgery. There was no statistically significant difference between the approaches in terms of complication rates, surgical conversion, need for intensive care, blood transfusion or early readmission. Both approaches demonstrated a similar safety profile in the surgical treatment of endometriosis. In this experienced tertiary center, robotic-assisted surgery was associated with greater perioperative effectiveness; because the disease-severity and case-complexity of each group could not be formally quantified, this association should be interpreted as hypothesis-generating and confirmed by prospective, adjusted studies before it informs a general recommendation on surgical approach.