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The two studies we reviewed
Voiding dysfunction after robotic surgery for colorectal endometriosis
A. Madar, Y. Dabi & É. Daraï · Paris, France
Systematic review and meta-analysis · 11 studies · 728 patients (503 robot / 225 laparoscopy) · JMIG 2026
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The robot dilemma in endometriosis surgery
A.C.P. Servidoni, H.S. Taylor (Yale) & M.S. Abrão · São Paulo, Brazil
Systematic review and meta-analysis · 16 studies · 2,450 patients (operative time analysis) · JMIG 2026
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Both published in Journal of Minimally Invasive Gynecology · 2026
What the evidence says · 2026
Two meta-analyses published this year seem to disagree. Read together, they give a clear answer: it depends on where the disease is.
Source Journal of Minimally Invasive Gynecology · 2026 · two systematic reviews (meta-analyses)
By Dr. César Cantú · Laparoscopic gynecologic surgery, Monterrey, Mexico · 4 min read
When deep endometriosis needs surgery, the same question comes up: robot or laparoscopy? The honest answer is not “newer is better.” In 2026, two systematic reviews were published in the Journal of Minimally Invasive Gynecology that, at first glance, point in opposite directions. They are worth reading carefully, because the right decision changes with the case.
What it examined: difficulty urinating after operating on deep endometriosis next to the rectum. It pooled 11 studies and 728 patients (503 robot, 225 laparoscopy).
What it found: voiding dysfunction in 4.4% with robot vs 13.3% with laparoscopy (RR 0.33). When it persisted beyond one month: 5.2% vs 10.2%. The robot's precision protects the bladder nerves.
Takeaway: in patients at high urinary risk, the robot is preferable.
What it examined: overall outcomes of robot vs laparoscopy across all types of endometriosis. It pooled 16 studies; 2,450 patients in the operative time analysis.
What it found: laparoscopy was about 26 minutes faster. No differences in bleeding, conversion to open surgery, hospital stay or complications. (In a single study there was less pain with the robot: 40.5% vs 76.7%.)
Takeaway: neither technique is superior “in general”; the decision is individualized.
The key is where it's measured. The second study averages all endometriosis, including superficial and ovarian disease, where the robot adds little and costs time. The first zooms in on the hard scenario: deep disease, stuck to the rectum and to the nerves that control the bladder. There, the robot's precision means less nerve injury and less urinary retention.
This connects with a principle of endometriosis surgery guided by the pelvic nerve anatomy: the goal is not only to remove the disease, it is to leave the bladder, bowel and sexual function intact. The tool is chosen by the case, not by fashion.
If endometriosis surgery is ahead, the useful question isn't “do you have a robot?” but “how much experience does the surgical team have with this type of disease, and how do they protect the bladder nerves?” In deep cases near the rectum, the right technology helps preserve urinary function. In simpler cases, what matters is experience, not the machine.
Do you have endometriosis and want to understand the best option for your case?
Book a consultationMadar A, Ferrier C, Dabi Y, Dahan M, Zerbib E, Touboul C, Daraï E. Voiding dysfunction after robotic-assisted laparoscopic surgery for colorectal endometriosis: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2026. doi:10.1016/j.jmig.2026.07.026
Servidoni ACP, Tristão LS, Lemos MJ, et al. (Abrão MS). The robotic trade-off in endometriosis surgery: robot-assisted versus conventional laparoscopy — a systematic review and meta-analysis. J Minim Invasive Gynecol. 2026. doi:10.1016/j.jmig.2026.09.469
Educational content. It does not replace individual medical assessment. The surgical indication is defined case by case in consultation.