Role of robot-assisted laparoscopy in deep-infiltrating endometriosis with bowel involvement: a systematic review and application of the IDEAL framework

Abstract Aims This review aims to evaluate the feasibility of robot-assisted laparoscopic surgery (RALS) as an alternative to standard laparoscopic surgery (SLS) for the treatment of bowel deep-infiltrative endometriosis (1). Additionally, it aims to provide guidance for future study design, by gaining insight into the current state of research, in accordance with the IDEAL framework. Method A systematic review was conducted to identify relevant studies on RALS for bowel deep infiltrating endometriosis (BDIE) in Medline, Embase, Cochrane Library, and PubMed databases up to August 2023 and reported in keeping with PRISMA guidelines, The study was registered with PROSPERO Registration: CRD42022308611 Results 11 primary studies were identified, encompassing 364 RALS patients and 83 SLS patients, from which surgical details, operative and postoperative outcomes were extracted. In the RALS group, mean operating time was longer (235 ± 112 min) than in the standard laparoscopy group (171 ± 76 min) (p < 0.01). However, RALS resulted in fewer postoperative complications (15.3%) compared to standard laparoscopy (26.5%). Patients in the RALS group experienced a shorter hospital stay (5.3 ± 3.5 days vs. 7.3 ± 4.1 days) (p < 0.01). Research evidence for RALS in BDIE is at an IDEAL Stage 2B of development. Conclusion RALS is a safe and feasible alternative to standard laparoscopy for bowel endometriosis treatment, potentially improving rates of intraoperative and overall postoperative complications despite longer operating times.