Application of Robotic Surgery in the treatment of endometriosis: View point of an Indian OBGYN fellow in USA


  • Krishna Kavita Ramavath Physician Observer Fellow, South Florida Baptist Hospital, Affiliated to Florida International University, Florida, USA
  • Manuel A. Penalver Chair of Obstetrics & Gynecology, Florida International University, Florida, USA
  • Luis E. Mendez South Florida Gynecological Oncologist, Doctors Hospital, Coral Gables, Florida, USA
  • Olyai Roza Olyai Hospital, Gwalior, Madhya Pradesh, India


Endometriosis, Robotic surgery, Surgical outcomes, da vinci, Minimal invasive surgery


Background: This article is an observational experience of robotic surgery in USA by an Indian Obgyn fellow. Primary objective is to analyze retrospectively peri operative outcomes in stage 2 and 3 Endometriosis treated with robot assisted laparoscopy. Secondary objective is to report an Indian Obgyn, Physician observer fellows experience in USA with Robotic surgery.  

Methods: 29 women underwent robotic surgery at in the department of gynecology at Doctor’s hospital, Baptist health, Miami. Pre-op time, console time, total operative time, blood loss, peri-operative complications noted.

Results: Mean age is 42 ± 8 years with BMI of 26.2 ± 8 kg/m2. Eighteen patients (62%) were age 40 and above. Twenty patients (69%) presented with chronic pelvic pain. Dyspareunia in 16 (55.2%), bloating in five (17.2%) and pelvic mass in thirteen (44.8%)  Unilateral pelvic mass in nine patients (31 %) and bilateral in four patients (13.8%). CA 125 levels are elevated in nine patients (31%) and significantly higher with endometriomas (76.1 ± 49.2 U/ml). 38% underwent robot assisted laparoscopic hysterectomy and BSO. 14.8% underwent robot assisted laparoscopic hysterectomy with Robot (LSO/RSO). Mean operative time 64.7 min. Mean blood loss 40 ml.  

Conclusions: Robotic surgery is safe, with minimal blood loss and shorter hospital stay. Alike in the surgical techniques, though diverse in the work infrastructure and technology, East and West have common scenarios which can be tackled with exchange of training opportunities. This interchange of knowledge and skills will benefit patients with increased surgeon’s efficiency. 


Catenacci M, Flyckt RL, Falcone T. Robotics in reproductive surgery: strengths and limitations. Placenta. 2011;32(3):232-7.

Endometriosis Research Center. Understanding endometriosis: past, present and future, 2005. The National Women’s health Information Council. Available at:

Nezhat C, Lewis M, Kotikela S, Veeraswamy A, Saadat L, Hajhosseini B, et al. Robotic versus standard laparoscopy for the treatment of endometriosis. Fertil Steril. 2010;94:2758-60.

Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364:1789-99.

Nezhat C, Hajhosseini B, King LP. Robotic-assisted laparoscopic treatment of bowel, bladder, and ureteral endometriosis. JSLS. 2011 Jul-Sep;15(3):387-92.

Joel Cardenas-Goicoechea, Sarah Adams, Suneel B. Bhat, Thomas C. Randall. Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center. Gynecol Oncol. 2010 May;117(2):224-8.

Cheng YM, Wang ST, Chou CY. Serum CA-125 in preoperative patients at high risk for endometriosis. Obstet Gynecol. 2002;99:375-80.

Liu C, Perisic D, Samadi D, Nezhat F. Robotic-assisted laparoscopic partial bladder resection for the treatment of infiltrating endometriosis. J Minim Invasive Gynecol. 2008 Nov-Dec;15(6):745-8.

Ercoli A, D’asta M, Fagotti A, Fanfani F, Romano F, Baldazzi G, et al. Robotic treatment of colorectal endometriosis: technique, feasibility and short-term results. Hum Reprod. 2012;27(3):722-6.

Ness RB, Cramer DW, Goodman MT, Kjaer SK, Mallin K, Mosgaard BJ, et al. Infertility, fertility drugs, and ovarian cancer: a pooled analysis of case-control studies. Am J Epidemiol. 2002;155:217-24.

Brinton LA, Sakoda LC, Sherman ME, Frederiksen K, Kjaer SK, Graubard BI, et al. Relationship of benign gynecologic diseases to subsequent risk of ovarian and uterine tumors. Cancer Epidemiol Biomarkers Prev. 2005;14:2929-35.

Magrina JF. Robotic surgery in gynecology. Eur J Gynaecol Oncol. 2007;28(2):77-82.

Leddy, Laura Sigismund, Thomas S. Lendvay, Richard M. Satava. Robotic surgery: applications and cost effectiveness. Open Access Surg. 2010;3:99-107.

Delaney CP, Lynch AC, Senagore AJ, Fazio VW. Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum. 2003;46:1633-9.

Lenihan JP Jr, Kovanda C, Seshadri-Kreaden U. What is the learning curve for robotic assisted gynecological surgery? J Minim Invasive Gynecol. 2008;15(5):589-94.

Lasser MS, Patel CK, Elsamra SE, Renzulli JF, Haleblian GE, Pareek G. Dedicated robotics team reduces pre-surgical preparation time. Indian J Urol. 2012;28:263-6.

Sutton CJG, Ewen SP, Whitelaw N, Haines P. Prospective, randomized, double blind controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. Fertil Steril. 1994;62;696-700.

Parker JD, Sinaii N, Sears JH, Godoy H, Winkel C, Stratton P. Adhesion formation after laparoscopic excision of endometriosis and lysis of adhesions. Fertil Steril. 2005;84:1457-61.

Nezhat C, Lavie O, Lemyre M, Unal E, Nezhat CH, Nezhat F. Robot-assisted laparoscopic surgery in gynecology: scientific dream or reality? Fertil Steril. 2009;91:2620-2.

Nezhat C, Saberi NS, Shahmohamady B, Nezhat F. Robotic-assisted laparoscopy in gynecological surgery. JSLS. 2006;10(3):317-20.






Original Research Articles