Robotic management of endometriosis: where do we stand?

The progressive and chronic nature of this disease can have a substantial impact on both quality of life and functioning of women who suffer from the disease. While medical treatment can be sufficient therapy for many women with endometriosis, medical therapies are often inadequate for the severest cases. The anatomic changes of adhesions/fibrosis and smooth muscle metaplasia that are associated with endometriosis, however, can be substantial and surgery for this disease can be technically challenging. Historically, the severest cases of endometriosis were managed using a laparotomy approach. Traditional laparoscopy has gained popularity for the management of this disease but has limitations in the surgical treatment of the most difficult cases of endometriosis. With the introduction of the robotic surgical platform, experience has gradually accumulated regarding its application for surgical management of deeply infiltrating endometriosis (DIE). It has been suggested that the robotic platform enables more complex dissections and may be the ideal modality for the surgical management of endometriosis. As both experience and technology expand, the robotic platform is being utilized by an increasing number of surgeons and for increasingly complex minimally invasive pelvic surgery. The literature analyzing its actual performance in the management of DIE, however, is only just manifesting. This review focus on the surgical management of endometriosis by robotic laparoscopy. Specifically we describe the unique surgical challenges of this disease. We also highlight the current state of the literature that analyzes the application of robotic laparoscopy to the various anatomic and clinical manifestations of endometriosis and critique outcomes as they apply to the safety, efficacy and cost of this modality for the management of endometriosis.