# Impact of Minimally Invasive Surgery on Quality of Life and Infertility in Deep Infiltrating Endometriosis

## TL;DR

Minimally invasive surgery for deep infiltrating endometriosis can improve quality of life and fertility, but results vary and more consistent data is needed.

## Contribution

This paper reviews recent evidence on the impact of minimally invasive surgery on quality of life and fertility in deep infiltrating endometriosis.

## Key findings

- Laparoscopic and robotic MIS can improve quality of life and reproductive outcomes for patients with deep infiltrating endometriosis.
- The magnitude of benefit from MIS varies across studies, patient phenotypes, and follow-up periods.
- Validated QoL instruments like EHP-30, SF-36, and EQ-5D are essential for evaluating outcomes in endometriosis patients.

## Abstract

Background: Endometriosis is a chronic, estrogen-dependent inflammatory disease affecting up to 10% of women of reproductive age. It substantially impacts quality of life (QoL) through pelvic pain, infertility, and psychological distress. Increasing attention has been directed toward patient-reported outcomes and validated QoL instruments, which are essential for understanding the burden of disease and guiding individualized management. Materials and Methods: We performed a narrative review of the literature published in the last five years in PubMed, Scopus, Web of Science, and Cochrane Library, focusing on validated QoL instruments, fertility indices, and clinical outcomes after minimally invasive surgery (MIS) for deep infiltrating endometriosis (DIE). Discussions: The most widely used QoL instruments are the Endometriosis Health Profile-30 (EHP-30), Short Form-36 (SF-36), and EQ-5D, each providing multidimensional evaluation across physical, psychological, and social domains. Fertility-related prognosis is assessed with the Endometriosis Fertility Index (EFI), while staging of disease severity relies on rASRM and #ENZIAN classifications. Evidence from comparative and cohort studies suggests that both laparoscopic and robotic MIS can improve QoL and reproductive outcomes; however, the magnitude of benefit varies across studies, patient phenotypes, and follow-up periods. Conclusions: MIS is an increasingly used therapeutic option for DIE, with growing evidence of improvement in pain and QoL, but current data remain heterogeneous and do not uniformly support superiority over other approaches. Routine incorporation of validated QoL instruments and fertility indices into both clinical practice and research is essential to better stratify patients, support shared decision-making, and optimize long-term outcomes.