The Comparison of Robotic Single-Site Surgery to Single-Port Laparoendoscopic Surgery for the Treatment of Advanced-Stage Endometriosis

Objective: To compare perioperative outcomes of robotic single-site (RSS) surgery with conventional single-port laparoendoscopic surgery for the treatment of advanced-stage endometriosis. Materials and Methods: This is a retrospective cohort study that included 120 patients who received single-port laparoendoscopic surgery or RSS surgery for the treatment of advanced-stage endometriosis at Ewha Womans University's Mokdong Hospital in Seoul, Korea between December 2014 and May 2017. Single-port laparoendoscopic cystectomy and adhesiolysis were performed in 52 patients (Single-port laparoendoscopic [SPL] group) and RSS cystectomy and adhesiolysis were performed in 68 patients (RSS group). Perioperative outcomes that we analyzed, included age, operative time, estimated blood loss, length of hospital stay, size of endometriosis, laterality of endometriosis, degree of endometriosis infiltration (i.e., deep versus not), and recurrence. Results: The patients in both groups were of similar ages. Longer operative times (107.8 +/- 37.6 min for RSS group versus 76.9 +/- 46.4 min for SPL group, P=.001) and more estimated blood loss (106.67 +/- 171.67 mL for RSS group versus 57.1 +/- 44.9 mL for SPL group, P=.001) were measured in the RSS group. However, the mean size of endometriosis was statistically larger (5.23 +/- 2.53 cm for RSS group versus 4.37 +/- 2.14 cm for SPL group, P=.030) and higher rates of more deeply infiltrative endometriosis (52 cases in RSS group, 76.5% versus 33 cases in SPL group, 63.5%) were observed in RSS group. Multicystic endometriosis occurred in 26 cases in the RSS group (38.2%). No significant differences were seen in terms of length of hospital stay (4.58 +/- 0.61 of SPL group versus 4.59 +/- 0.58 of RSS group, P=.862) or intraoperative and postoperative complications between the groups. Recurrence occurred in one case in the RSS group (1.9%). Conclusion: RSS surgery can be used in the treatment of advanced-stage endometriosis, especially in more complicated cases.