Robotic endometriosis surgery leads to better fertility preservation outcomes

Endometriosis is a condition that causes tissue similar to the type that grows inside a woman's uterus to grow on the outside, often affecting the ovaries, fallopian tubes, and pelvic tissue. The most common endometriosis symptom is pelvic pain, particularly during menstrual periods, but women may also experience excessive menstrual bleeding and infertility.

Peter McGovern, M.D., a reproductive endocrinology and infertility specialist at Hackensack University Medical Center's Department of Obstetrics & Gynecology and clinical professor of Obstetrics & Gynecology at Rutgers New Jersey Medical School, said robotic surgery allows surgeons to treat endometriosis with minimal downtime for the patient and a better chance of preserving fertility.

Precise treatment for a challenging condition

Dr. McGovern said that endometriosis surgery is among the most challenging procedures a gynecological surgeon can perform. Because the excess tissue growing in the pelvis is similar to the tissue in the endometrium -; or the lining of the uterus -; it goes through the same changes and causes the same bleeding as the uterine lining does during a woman's menstrual cycle.

But unlike the endometrial tissue in the uterus, excess tissue in the pelvis cannot exit the body. This trapped tissue can lead to inflammation in the pelvis and create scar tissue or abnormal bands of tissue called adhesions.

Everything just gets stuck to everything else, which makes for very challenging surgical cases. This excess tissue growth can even cause endometriomas, or cysts on the ovaries, and lead to fertility problems."

Dr. Peter McGovern, M.D., Reproductive Endocrinology and Infertility Specialist, Hackensack University Medical Center

Dr. McGovern and his colleagues perform some endometriosis surgeries using the state-of-the-art da Vinci multiport robotic surgical system. Three of the system's robotic arms hold small surgical instruments, and the fourth arm has a small video camera. The instruments and camera are inserted into the body through small incisions. The camera transmits a magnified 3D video image of the pelvic organs onto a screen at the surgical console, where the surgeon sits and controls the robot.

With 10 years of experience performing robotic gynecological surgical procedures, Dr. McGovern said the precision of robotic surgery is especially beneficial for endometriosis. Using multiple robotic arms inserted into several small incisions also allows surgeons to see and access nearly the entire pelvic area.

"We use robotic surgery for advanced endometriosis cases or subsequent surgeries because it allows for greater articulation of movement and increased dexterity," said Dr. McGovern. "The enhanced visibility and precision also allow surgeons to work in very small spaces while reducing the risk of damage to pelvic structures."

Benefits for patients

According to Dr. McGovern, patients notice the benefits of robotic surgery, too.

"Most of my patients are surprised at how quickly they recover, particularly if they have had open surgery before for another condition," said Dr. McGovern. "Because of the smaller incisions, we are also able to minimize the need for opioid painkillers and use other non-opioid methods of pain control."

And, since Dr. McGovern's practice is focused on infertility care, he said he always takes a "fertility-directed" approach to robotic endometriosis surgery, leading to better fertility preservation outcomes.

"I can treat endometriosis with minimal damage to the uterus, and I can almost always preserve the ovary -; even when removing a cyst," said Dr. McGovern. "After the cyst is removed, the robot allows me to use a fine suture to close the ovary, which minimizes bleeding and scar tissue."