Robotic surgery for endometriosis is a surgery that uses a doctor-guided mechanical system in place of handheld instruments. While it has similar outcomes and risks to traditional procedures, higher costs and specialized training requirements affect its availability.

Robotic surgery for endometriosis is a style of surgery — like laser surgery or electrosurgery. It allows your surgeon to manipulate surgical instruments using mechanical arms instead of handheld tools.

These arms are maneuvered using a console that provides a multi-dimensional view of the surgical area. Your surgeon uses hand and foot controls to instruct the precise movements of the robotic arms.

Robotic surgery is typically used to enhance the precision of minimally invasive procedures like laparoscopy. It is rarely used in laparotomy for endometriosis.

Laparoscopy is the most common surgical approach for endometriosis. Also known as “keyhole surgery,” it involves making multiple small incisions in the abdomen to allow the insertion of a laparoscope and specialized surgical equipment.

Laparotomy, known as open surgery, involves making a larger midline incision in the abdomen. Instead of using a viewing tool like the laparoscope, a laparotomy provides direct access and visuals through the opening in your abdomen.

Laparoscopy is considered the “gold standard” of endometriosis surgery and is associated with shorter surgical times and faster recovery.

Endometriosis lesions, clusters of cells resembling the uterine lining, can develop almost anywhere in your body. Lesions can eventually lead to adhesions or bands of scar tissue between other internal structures.

Your surgeon may recommend robotic surgery for endometriosis if lesions or adhesions are abundant, in challenging locations, or if your procedure carries a high risk for complications from other factors.

By using robotic arms to control surgical tools, your doctor is able to operate with a higher level of precision that can allow smaller surgical incisions, less trauma to surrounding tissues, enhanced visibility, and a greater range of motion for complex procedures.

Robotic systems can also help reduce fatigue-related challenges, like shaking hands, which surgeons might otherwise experience during long operations.

According to a 2020 review, robotic surgery for endometriosis appears to be most beneficial when:

  • severe pelvic adhesions are present and require delicate removal to preserve the anatomy and function of the pelvic cavity
  • preservation of pelvic anatomy is essential to managing endometriosis pain
  • bowel or urinary tract surgery with high complication rates is also needed
  • there is a high chance laparoscopy would be converted to laparotomy

Preparation for robotic endometriosis surgery is the same as that of traditional approaches.

In the days before your procedure, your doctor will provide instructions about how to adjust current medications, how to cleanse your surgical site, and when to stop eating and drinking.

You may be asked to remove all makeup, jewelry, and nail polish to help prevent interference with surgical equipment or monitoring devices.

Most surgical teams recommend arriving at the hospital in comfortable, loose clothing.

Because many people aren’t up to driving after the operation, pre-arranging transport to and from the hospital is also recommended.

After you arrive at the hospital, a pre-surgical assessment is done to ensure no major changes have happened since you last spoke with your doctor.

Additional laboratory testing, fluid therapy, and monitoring equipment may be set up during this time as well.

Once you enter the surgical suite, you’ll receive a sedative through an intravenous (IV) catheter. This induces general anesthesia, which is then maintained using an anesthetic/oxygen mixture carried to the lungs through an endotracheal tube.

When you’re fully anesthetized, the surgical team positions you appropriately for your surgery and orients the robotic arms of the surgical system. Even though your surgeon will be at a console to perform your procedure, the surgical team remains present to monitor your vitals and provide other assistance.

Your surgeon sits at the robotic console, taking up the hand and foot controls. Your surgeon’s movement is translated to the robotic arms in real-time. The initial incisions are made, and a magnifying camera is placed inside your abdomen. Carbon dioxide is used to inflate your abdomen for better visibility.

Lesions and adhesions are identified using high-definition, magnifying cameras. Areas of concern are excised or removed using instruments on the robotic arms.

At the end of the surgery, the incisions are closed, and you’ll be taken to a special recovery area to wake up from anesthesia.

Your hospital stay will depend on your overall medical history, the procedures performed, what time of day you had surgery, how quickly your procedure went, and how well you woke up from anesthesia.

If you had a minimally invasive procedure like laparoscopy, you may go home the same day or the next day if your pain is manageable.

Recovery from a laparotomy is often longer. You may be in the hospital for several days while doctors monitor your incision site, watch for complications, and make sure you’re not in major discomfort.

Once home, it’s natural for your incision sites to feel sore and to experience general fatigue. You may notice decreased appetite or bowel habits — common aftereffects from anesthesia slowing your digestive system.

If you had a robotic laparoscopy for endometriosis, you may also notice sharp, transient pain in your upper body. This is often the result of leftover carbon dioxide.

Overall recovery times can vary between people, but you can expect to take it easy for at least 2 weeks postsurgery, with pushing and pulling restrictions for 6 weeks or longer.

In general, all surgery comes with potential risks related to:

  • bleeding
  • infection
  • tissue damage
  • anesthetic complications

According to the makers of the da Vinci System, one of the most widely used robotic systems in gynecological surgery, risks associated with robotic endometriosis surgery generally involve secondary damage to the bowels and structures of the bladder.

There may also be limitations to using robotic systems compared with traditional methods.

The 2020 review indicates robotic surgery often takes longer than other methods due to the time taken to position the robotic system and the lack of tactile (touch) feedback to your surgeon.

Without tactile feedback, surgeons may not be able to assess factors like tissue firmness or texture, which can lead to delayed adjustments during surgery or inaccurate pressure application.

Surgical training in the use of robotics systems can also affect outcomes, and restricted camera positioning may make multi-region surgeries challenging.

According to a review from 2021, robotic surgery for endometriosis has similar outcomes and complication rates compared to traditional laparoscopy.

Due to its limited use, likely due to higher cost, more research is necessary to determine if robotic surgery significantly improves quality of life or patient satisfaction over other methods.

Overall, approximately 80% of people experience some reoccurrence of pain within 2 years of any endometriosis surgery.

Robotic surgery for endometriosis may be recommended for severe cases or those with a high chance of complications.

Robotic assistance allows for higher surgical precision and may be the best option to preserve the surrounding tissues unaffected by endometriosis.

Despite similar outcomes and risks compared to traditional endometriosis surgeries, robotic surgery may not be available for everyone due to higher costs and surgeon availability.