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What the evidence says · 2026
Removing the disease without damaging what controls the bladder, bowel and sexual life. Is it possible? The 2026 evidence answers.
By Dr. César Cantú · Laparoscopic gynecologic surgery, Monterrey, Mexico · 4 min read
If you're facing surgery for deep endometriosis, what makes the difference isn't the machine: it's whether the surgeon knows how to protect the nerves that control the bladder, bowel and sexual life. This is called nerve-sparing surgery.
The good news: 2026 evidence says it can be done safely —open surgery is almost never needed, and most women keep those functions well.
The fine print: results vary a lot from one surgeon to another. It's not a magic switch; it depends on the surgeon's experience.
Deep endometriosis grows exactly where the nerves that control the bladder, the rectum and sexual function run. Removing all the disease is the goal, but doing it without injuring those nerves is what separates a good operation from one that leaves lasting problems. A large 2026 study pooled the available evidence to answer a concrete question: is it safe, and how well is function preserved?
The study we reviewed
Published in Journal of Minimally Invasive Gynecology · 2026
What it examined: how many women kept good bladder, bowel and sexual function after nerve-sparing surgery for deep endometriosis.
What it found: open surgery was almost never needed (3 in 1,000). About 7 in 100 had trouble urinating, and around 10 in 100 had bowel discomfort. Sexual function was also measured, with variable results.
In plain words: it can be done, it's safe, and most women keep good function.
The most reassuring part is that open surgery is almost never needed: sparing the nerves does not force more aggressive operations. And the urinary and bowel problems were few for such advanced disease.
But there's a key point: results varied a lot between centers. That says something important — nerve-sparing is not automatic: it depends on knowing the pelvic nerve anatomy and operating carefully. The benefit doesn't come from the label, it comes from how it's done.
This is why it connects to the surgical tool: in deep disease, precision (including the robot's) is exactly what helps respect those nerves.
If you're facing surgery for deep endometriosis, it's worth asking “will this be done sparing the nerves, and how much experience do you have with it?” It's not a trend: it's what protects your ability to urinate, have normal bowel movements and a normal sexual life afterwards. The evidence says it can be done; what makes the difference is the experience of the surgeon.
Do you have deep endometriosis and want to understand how function is protected in your case?
Book a consultationAloslani J, Alnwman J, Alsahli H, et al. Functional and surgical outcomes of nerve-sparing approaches in deep infiltrating endometriosis: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2026. doi:10.1016/j.jmig.2026.10.006
Educational content. It does not replace individual medical assessment. The surgical indication is defined case by case in consultation.