Visualization of endometriosis: comparative study of 3-dimensional robotic and 2-dimensional laparoscopic endoscopes

Cindy Mosbrucker, Anita Somani, John Dulemba

The main objective of this study was to compare results of using the robotic 3D/HD scope and the 2D/HD laparoscope for visual detection of histologically confirmed endometriosis. Three surgeons from different practices enrolled premenopausal women ≥18 years who had elected to undergo robotic-assisted endometriosis resection. Patients were randomized to receive 2D/HD laparoscopic visualization either before or after 3D/HD robotic visualization. Resections then proceeded robotically. The number of histologically confirmed lesions overall and by abdomino-pelvic location, appearance and size was compared by scope type used. During the study, 598 lesions were visualized in 98 patients. Average number of lesions per patient using either scope was 6.1. Mean age was 31 years and 77% were disease stage I/II. On histopathology, 58.4% of lesions resected were consistent with endometriosis. All (100%) of these lesions were detected using the robotic 3D/HD scope and 77.9% using the 2D/HD laparoscope (p < 0.001). Compared to laparoscopic, robotic visualization resulted in detection of more confirmed lesions in all anatomic locations and for most appearances, including the cul-de-sac (100 vs. 79%), atypical appearance (100 vs. 71.3%) and width <5 mm (100 vs. 62%), p's < 0.001). Logistic regression indicated that use of the 3D/HD robotic scope was independently associated with 2.36 times the likelihood (95% CI 1.20, 4.66; p = 0.014) of detecting a confirmed lesion, compared to the 2D/HD laparoscope. Large-scale, long-term studies are needed to substantiate these findings in multiple practice settings and to determine whether 3D robotic versus 2D laparoscopic resection has a beneficial impact on symptomatology, recurrence and fertility outcomes.