{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T16:53:52Z","timestamp":1793379232980,"version":"4.5.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100019559","name":"Carl von Ossietzky Universit\u00e4t Oldenburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100019559","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The objective of this work was to compare the perioperative safety and operative efficacy of robotic-assisted surgery (RAS) versus conventional laparoscopy surgery (CLS) in women with symptomatic colorectal endometriosis, with particular focus on to the anatomical disease complexity as defined by the #Enzian system. We retrospectively reviewed 160 consecutive cases operated for colorectal endometriosis at a single referral center between 2022 and 2025. Patients were managed by RAS (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200959) or CLS (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009101) in a non-randomized, sequential setting, with CLS performed prior to the implementation of RAS at our center. Intraoperative variables (operative time, blood loss, number of trocars, conversion rate) and perioperative outcomes (length of stay, transfusion, intensive-care admission, complications, reoperation, readmission, anastomotic leakage, and C-reactive protein serum levels on postoperative days 1\u20133 were analyzed. Anatomical disease extent was assessed using the #Enzian classification, including compartments P, O, T, A, B, C and F-compartments (FA, FB, FI, FU, F-nerves, F-diaphragm). Continuous variables were compared using the Mann\u2013Whitney U test and categorical variables using Fisher\u2019s exact test, with\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05 considered statistically significant. Complete excision of colorectal endometriosis and additional lesions was achieved with either route in all cases, with a very low overall rate of anastomotic leakage (2\/160; 1.3%). Anatomical complexity was significantly higher in the RAS group, with more frequent peritubal\/periovarian adhesions (T) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002), advanced rectal (C) lesions (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003), and increased involvement of the bladder (FB) (8.5% vs. 0.0%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.006), ureter (FU) (11.9% vs. 2.0%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.013), and diaphragm (10.2% vs. 0.0%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002). Despite this, median operative time was comparable between groups (225 [150\u2013292] vs. 201 [146\u2013251] minutes,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.188). Length of hospital stay was significantly shorter after RAS (5 [4\u20136] vs. 6 [4\u20137] days,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008). Overall complication rates were similar (10.2% vs. 12.9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.80), and the reoperation rate was numerically lower in the RAS group (1.7% vs. 6.9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.26). RAS and CLS are both safe and effective surgical approaches for excision of symptomatic colorectal endometriosis. Despite being used in anatomically more complex cases, RAS achieved perioperative outcomes comparable to CLS, with a shorter length of hospital stay and a numerically lower reoperation rate. These findings underscore the importance of accounting for anatomical complexity and disease extent when comparing outcomes in deep endometriosis surgery. Prospective risk-adjusted or propensity score\u2013matched studies are warranted to confirm these results.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>What is new?<\/jats:bold>\n                    RAS achieves comparable perioperative outcomes to CLS in colorectal endometriosis and is associated to shorter hospitalization, despite being preferentially used in anatomically more complex cases defined by the #Enzian classification.\n                  <\/jats:p>","DOI":"10.1007\/s11701-026-03634-9","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:31:08Z","timestamp":1784539868000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Robotic-assisted compared to conventional laparoscopic surgery for colorectal endometriosis: perioperative outcomes in the context of #Enzian-defined anatomical complexity"],"prefix":"10.1007","volume":"20","author":[{"given":"Harald","family":"Krentel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Burla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Tanovska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Klein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Hoche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Constantin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. S.","family":"de Wilde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Devassy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Keckstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Vlachodimitris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Sklavounos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Andrikos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"issue":"11","key":"3634_CR1","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1038\/s41574-019-0245-z","volume":"15","author":"C Chapron","year":"2019","unstructured":"Chapron C, Marcellin L, Borghese B, Santulli P (2019) Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 15(11):666\u2013682 PMID: 31488888","journal-title":"Nat Rev Endocrinol"},{"issue":"3","key":"3634_CR2","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1093\/humupd\/dmv003","volume":"21","author":"MS Abr\u00e3o","year":"2015","unstructured":"Abr\u00e3o MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C (2015) Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 21(3):329\u2013339 PMID: 25618908","journal-title":"Hum Reprod Update"},{"issue":"3","key":"3634_CR3","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.jmig.2020.08.015","volume":"28","author":"S Bendifallah","year":"2021","unstructured":"Bendifallah S, Puchar A, Vesale E, Moawad G, Dara\u00ef E, Roman H (2021) Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 28(3):453\u2013466 Epub 2020 Aug 22. PMID: 32841755","journal-title":"J Minim Invasive Gynecol"},{"issue":"7","key":"3634_CR4","doi-asserted-by":"publisher","first-page":"2029","DOI":"10.1007\/s00464-012-2153-3","volume":"26","author":"M Ceccaroni","year":"2012","unstructured":"Ceccaroni M, Clarizia R, Bruni F, D\u2019Urso E, Gagliardi ML, Roviglione G et al (2012) Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial. Surg Endosc 26(7):2029\u20132045 PMID: 22278103","journal-title":"Surg Endosc"},{"issue":"7","key":"3634_CR5","doi-asserted-by":"publisher","first-page":"2758","DOI":"10.1016\/j.fertnstert.2010.04.031","volume":"94","author":"C Nezhat","year":"2010","unstructured":"Nezhat C, Lewis M, Kotikela S, Veeraswamy A, Saadat L, Hajhosseini B, Nezhat C (2010) Robotic versus standard laparoscopy for the treatment of endometriosis. Fertil Steril 94(7):2758\u20132760 PMID: 20667540","journal-title":"Fertil Steril"},{"issue":"3","key":"3634_CR6","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1007\/s00404-025-08081-9","volume":"312","author":"H Krentel","year":"2025","unstructured":"Krentel H, Samartzis N, Kalaitzopoulos DR, Constantin AS, Schweppe KW, Metzler JM, Andrikos D, Witzel I, De Wilde RL, Keckstein J, Burla L (2025) Current status of robot-assisted surgery implementation in endometriosis centers: an international multicentric cross-sectional study. Arch Gynecol Obstet 312(3):871\u2013883. https:\/\/doi.org\/10.1007\/s00404-025-08081-9 Epub 2025 Jun 12. PMID: 40506623; PMCID: PMC12374906","journal-title":"Arch Gynecol Obstet"},{"key":"3634_CR7","doi-asserted-by":"crossref","unstructured":"Soto E, Luu TH, Liu X, Magrina JF, Wasson MN, Einarsson JI, Hughes D, Pinto R, Escobar P, Falcone T (2017) Laparoscopy vs. Robotic Surgery for Endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril. ;107(4):996\u20131002.e3. PMID: 28238492","DOI":"10.1016\/j.fertnstert.2016.12.033"},{"issue":"5","key":"3634_CR8","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1007\/s11701-020-01061-y","volume":"14","author":"S Restaino","year":"2020","unstructured":"Restaino S, Mereu L, Finelli A, Spina M, Ros J, Ferrari F et al (2020) Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robot Surg 14(5):687\u2013694 PMID: 31989438","journal-title":"J Robot Surg"},{"issue":"5","key":"3634_CR9","first-page":"1058","volume":"28","author":"D Raimondo","year":"2021","unstructured":"Raimondo D, Mabrouk M, Zannoni L, Arena A, Zanello M, Benfenati A et al (2021) Clinical outcomes after robotic-assisted vs conventional laparoscopic surgery for deep infiltrating endometriosis: a propensity score-matched study. J Minim Invasive Gynecol 28(5):1058\u20131065 PMID: 32791310","journal-title":"J Minim Invasive Gynecol"},{"issue":"7","key":"3634_CR10","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1111\/aogs.14099","volume":"100","author":"J Keckstein","year":"2021","unstructured":"Keckstein J, Saridogan E, Ulrich UA, Sillem M, Oppelt P, Schweppe KW et al (2021) The #Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand 100(7):1165\u20131175 PMID: 33483970","journal-title":"Acta Obstet Gynecol Scand"},{"key":"3634_CR11","doi-asserted-by":"publisher","unstructured":"Crestani A, Le Gac M, de Labrouhe \u00c9, Touboul C, Bendifallah S, Ferrier C, Dabi Y, Darai E (2024) Outcomes of discoid excision and segmental resection for colorectal endometriosis: robotic versus conventional laparoscopy. J Robot Surg. ;18(1):87. https:\/\/doi.org\/10.1007\/s11701-024-01854-5. PMID: 38386205","DOI":"10.1007\/s11701-024-01854-5"},{"key":"3634_CR12","doi-asserted-by":"publisher","unstructured":"Zhang X, Zhang X (2025) Comparison of perioperative outcomes between robotic surgery and traditional laparoscopy for colorectal endometriosis: a systematic review and meta-analysis. J Robot Surg. ;19(1):239. https:\/\/doi.org\/10.1007\/s11701-025-02374-6. PMID: 40418406","DOI":"10.1007\/s11701-025-02374-6"},{"issue":"9","key":"3634_CR13","doi-asserted-by":"publisher","first-page":"1740","DOI":"10.1111\/aogs.14170","volume":"100","author":"D Raimondo","year":"2021","unstructured":"Raimondo D, Alboni C, Orsini B, Aru AC, Farulla A, Maletta M, Arena A, Del Forno S, Sampogna V, Mastronardi M, Petrillo M, Seracchioli R (2021) Comparison of perioperative outcomes between standard laparoscopic and robot-assisted approach in patients with rectosigmoid endometriosis. Acta Obstet Gynecol Scand 100(9):1740\u20131746. https:\/\/doi.org\/10.1111\/aogs.14170 Epub 2021 Jun 10. PMID: 33999408; PMCID: PMC8453718","journal-title":"Acta Obstet Gynecol Scand"},{"key":"3634_CR14","doi-asserted-by":"publisher","unstructured":"Buhas BA, Skowron O, Si\u00e9 M, de Vergie S, Potiron E, Miaadi N, Pasticier G, Vuong NS, Brureau L, Almeras C, Azancot V, Beauval JB, Belas O, De Fourmestraux A, Bommelaere T, Deffar N, Gourtaud G, Guillotreau J, Nguyen TA, Pashootan P, Poinas G, Peyrottes A, Rouffilange J, Roumigui\u00e9 M, Rouvellat P, Van Hove A, Pettenati C, Prad\u00e8re B, de la Taille A, Fiard G, Dariane C, Ploussard G (2025) Impact of intra-abdominal pressure with AirSeal\u00ae system on patient-reported outcomes and experience measurements after robot-assisted radical prostatectomy. World J Urol. ;43(1):574. https:\/\/doi.org\/10.1007\/s00345-025-05958-x. PMID: 40996505","DOI":"10.1007\/s00345-025-05958-x"},{"issue":"2","key":"3634_CR15","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s11701-020-01104-4","volume":"15","author":"CE Foley","year":"2021","unstructured":"Foley CE, Ryan E, Huang JQ (2021) Less is more: clinical impact of decreasing pneumoperitoneum pressures during robotic surgery. J Robot Surg 15(2):299\u2013307. https:\/\/doi.org\/10.1007\/s11701-020-01104-4 Epub 2020 Jun 22. PMID: 32572753","journal-title":"J Robot Surg"},{"key":"3634_CR16","doi-asserted-by":"publisher","unstructured":"Ferrier C, Le Gac M, Kolanska K, Boudy AS, Dabi Y, Touboul C, Bendifallah S, Dara\u00ef E (2022) Comparison of robot-assisted and conventional laparoscopy for colorectal surgery for endometriosis: A prospective cohort study. Int J Med Robot. ;18(3):e2382. https:\/\/doi.org\/10.1002\/rcs.2382. Epub 2022 Mar 1. PMID: 35178837","DOI":"10.1002\/rcs.2382"},{"issue":"2","key":"3634_CR17","doi-asserted-by":"publisher","first-page":"127","DOI":"10.52054\/FVVO.16.2.012","volume":"16","author":"G Condous","year":"2024","unstructured":"Condous G, Gerges B, Thomassin-Naggara I, Becker C, Tomassetti C, Krentel H, van Herendael BJ, Malzoni M, Abrao MS, Saridogan E, Keckstein J, Hudelist G (2024) Intersociety Consensus Group. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement\u2020\u2021. Facts Views Vis Obgyn 16(2):127\u2013144 PMID: 38807551; PMCID: PMC11366111","journal-title":"Facts Views Vis Obgyn"},{"issue":"4","key":"3634_CR18","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.jviscsurg.2020.08.015","volume":"158","author":"H Roman","year":"2021","unstructured":"Roman H, Marabha J, Polexa A, Prosszer M, Huet E, Hennetier C, Tuech JJ, Marpeau L (2021) Crude complication rate is not an accurate marker of a surgeon\u2019s skill: A single surgeon retrospective series of 1060 procedures for colorectal endometriosis. J Visc Surg 158(4):289\u2013298 Epub 2021 Jan 12. PMID: 33451966","journal-title":"J Visc Surg"}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03634-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-026-03634-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03634-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:31:10Z","timestamp":1784539870000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-026-03634-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3634"],"URL":"https:\/\/doi.org\/10.1007\/s11701-026-03634-9","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"assertion":[{"value":"25 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All patients included in this analysis provided authorization both for the surgical intervention itself and for the anonymous use of their data.","order":2,"name":"Ethics","label":"Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"705"}}