ROBOTIC SURGERY IN ENDOMETRIOSIS .pdf

How to clear endometriosis by robotic surgery

1. ROBOTIC SURGERY IN
ENDOMETRIOSIS –CURRENT AND
FUTURE PERSPECTIVE
Dr. Chi Mi Scheible
October 25, 2025

2. About me
Dr. med. Chi Mi Scheible
My background and affiliations
Specialty OBGYN and gyn-oncology
Education
University of Witten/Herdecke
Residency
Two years GEN Helios Idstein
OBGYN Limburg, Krefeld, Mönchengladbach
Deputy director/ senior physician
Bethesda KrankenhausMönchengladbach and
JohanniterKrankenhausBonn
Certifications
MIC II, Robotic surgeon since 05/2023
Gyn-oncology

3. no conflicts of interest regarding thispresentation

4. Future Perspectives
Conclusion
06
Limitations
05
Evidence and outcomes
04
Current applications in
endometriosis
03
Robotic technology and
surgical principles
02
Introduction
01
OUTLINE

5. 01
INTRODUCTION
•Endometriosis is heterogeneous
•Infertility, pain, Quality of life
•Estrogen dependent, chronichinflammation
•Is surgical treatment necessary? Rationale for robotic surgery

6. CHALLENGES OF SURGERY IN DEEP
INFILTRATING ENDOMETRIOSIS
pain
inflammation
fibrosis
malignant
transformation
fertility
adhesions
complications
in pregnancy

7. IS SURGICAL TREATMENT NECESSARY?
RATIONALE FOR ROBOTIC SURGERY
Goals
•Relief of pain and improvement of quality of life
•Preservation of fertility
•Radical excision of lesions to reduce recurrence
•Preservation of nerves, blood supply, integrity of
surrounding organs
Advantages in robotics
•high definitionenhanced3D vision,
magnified view
•Wristed instruments –7degreesof
freedom
•Tremor filtration and motion scaling
•Improved ergonomics for the surgeon
•Improved precision in narrow spaces

8. 02
ROBOTIC TECHNOLOGY AND SURGICAL PRINCIPLES
1999
January
2006
April
2014
May
2017
May
2018
April
2009
First-generation
Da Vinci
Second-generation
Da Vinci S
Fourth-generation
Da Vinci Xi Da Vinci X Da Vinci SP*
Third-generation
Da Vinci Si
Evolution of da Vinci technology for all specialties
20+ years of advanced robotic-assisted surgery learning and development

9. •Senhance® Surgical
System
•others•Versius® Surgical System
•https://www.medtronic.com/covidien/en-
gb/robotic-assisted-surgery/hugo-ras-
system/products-and-system.html
•Hinotori
•KangDuo
•…
OTHER ROBOTIC SURGICAL SYSTEMS
•Hugorobotic-assisted
surgery (RAS) system
https://de.images.search.yahoo.com/yhs/search
CMR Surgical
Medtronic AsensusSurgical
https://www.medicalexpo.de/prod/asensus-
surgical/product-301264-1017561.html

10. ADVANTAGES OF ROBOTICS
•Angled instruments
•Stable 3D view
•Camera control by surgeon
•No tremor
•Improved mobility in tight spaces
•More precision
•Better visualization

11. ADVANCED TECHNOLOGIES
•Da Vinci Xi System
multi-quadrant
access
•Firefly fluorescence
imaging
•Vessel Sealer
Extend/
SynchroSeal
•Visualization and camera control
Scope flip / port hopping
•Da Vinci fourth-generation
advanced technology that
brings value to my practice
•Vessel Sealer:
Omentectomy
•SynchroSeal:DIE,
bowel resection
•Firefly:lymph node
resection,
Myomectomy
•EndoWristsuction
irrigator: endometriosis
resection,
myomectomy

12. 03
CURRENT APPLICATIONS IN ENDOMETRIOSIS
•Deep infiltration endometriosis (DIE): rectovaginal space, bowel, bladder, ureter
•severe adhesions or distorted pelvic anatomy
•Multidisciplinary cases (urology/ colorectal)
•Fertility-preserving procedures
•Re-do surgeries

13. DA VINCI FOR GYN SURGERY
4 ARM PROCEDURE, DA VINCI X
•Example operating room
configuration tips
•Port placement
31 42
A
*

14. RECTUM ENDOMETRIOSIS, ADVANCED
TECHNOLOGY

15. MYOMECTOMY, ICG PATENCY TEST

16. DIE URETER

17. DIE RECTOSIGMOID

18. DIE DIAPHRAGMA

19. 04
EVIDENCE AND OUTCOMES
Pain relief similar to laparoscopy
Fertility comparable
Blood loss: slightly lower in robotic cases
Complication similar
Conversion rates low in both approaches

20. COMPARING MINIMALLY INVASIVE
LAPAROSCOPIC GYNECOLOGICAL
PROCEDURES
Alkatout, I., O’Sullivan, O., Peters, G., & Maass, N. (2024). Expanding Robotic-Assisted Surgery in Gynecology Using the Potential of anAdvanced Robotic
System. Medicina, 60(1), 53. https://doi.org/10.3390/medicina60010053
Meta-analyses and Randomized
Controlled Trials (RCTs) comparing
minimally invasive laparoscopic
gynecological procedures (LAP) to
robotically assisted surgeries (RAS),
ordered by level of evidence. OT:
Operative Time; LOS: Length of Hospital
Stay.

21. COMPARING MINIMALLY INVASIVE
LAPAROSCOPIC GYNECOLOGICAL
PROCEDURES
Alkatout, I., O’Sullivan, O., Peters, G., & Maass, N. (2024). Expanding Robotic-Assisted Surgery in Gynecology Using the Potential of anAdvanced Robotic
System. Medicina, 60(1), 53. https://doi.org/10.3390/medicina60010053

22. 05
LIMITATIONS
•Cost and Learning Curve
•Superiority? –Lack of randomized trials
•Accessibility and equity of care

23. 06
FUTURE PERSPECTIVES
•Integration of AI (navigation, visualization)
•Fluorescence imaging for nerve/ ureter
•Tele-mentoring/ remote surgery

24. CONCLUSION
•Valuable tool, especially for complex DIE
•No superiority yet, but clear advantages
•Cost reduction and further innovations may shift balance toward wider
adoption
•Surgeons comfort

25. REFERENCES
•Soto, E.; Luu, T.H.; Liu, X.; Magrina, J.F.; Wasson, M.N.; Einarsson, J.I.; Cohen, S.L.; Falcone, T. Laparoscopyvs.
RoboticSurgeryforEndometriosis(LAROSE): A multicenter, randomized, controlledtrial. Fertil. Steril. 2017
•Ackermann, J.; Baumann, J.; Pape, J.; Pahls, J.; Ruchay, Z.; Spüntrup, C.; Holthaus, B.; Noé, G.; Anapolski, M.;
MeinholdHeerlein, I.; et al. Factorsinfluencingsurgicalperformanceand learningprogressin minimallyinvasive
surgery—Resultsofan interdisciplinarymuticenterstudy. Int. J. Surg. 2023
•Alkatout, I.; Mechler, U.; Mettler, L.; Pape, J.; Maass, N.; Biebl, M.; Gitas, G.; Laganà, A.S.; Freytag, D. The
Development ofLaparoscopy—A Historical Overview. Front. Surg. 2021
•NezhatC, Lewis M, KotikelaS, VeeraswamyA, SaadatL, HajhosseiniB, NezhatC. Roboticversus standard
laparoscopyforthetreatmentofendometriosis. Fertil Steril. 2010 Dec;94(7):2758-60. doi:
10.1016/j.fertnstert.2010.04.031. Epub2010 May 26. PMID: 20537632.
•TerhoAM, Mäkelä-KaikkonenJ, OhtonenP, UimariO, PuhtoT, RautioT, KoivurovaS. Roboticversus
laparoscopicsurgeryforseveredeependometriosis: protocolfora randomisedcontrolledtrial (ROBEndo
trial). BMJ Open. 2022 Jul 18;12(7):e063572. doi: 10.1136/bmjopen-2022-063572. PMID: 35851028; PMCID:
PMC9297206.