# Preliminary Experience of Robotic Endometriosis From a Tertiary Care Center in India: The Learning Curve

## TL;DR

This study shows that robotic surgery for endometriosis is safe and effective in India, with low complication rates and improved patient outcomes.

## Contribution

The study provides preliminary evidence of robotic-assisted surgery's effectiveness for endometriosis in an Indian context, including complex cases.

## Key findings

- Robotic-assisted endometriosis surgery had minimal intraoperative and postoperative complications.
- Patients showed significant improvements in postoperative pain and quality of life scores.
- Operative efficiency improved over time, with a notable learning curve inflection point around case 28 in deep infiltrating endometriosis cases.

## Abstract

Background

Endometriosis often requires surgery, especially in deep-infiltrating cases unresponsive to medical therapy. This study presents our institutional experience with robotic-assisted surgery (RAS) for endometriosis in Indian patients.

Methodology

This retrospective study was conducted at a high-volume tertiary care center in India and included patients who underwent robotic-assisted endometriosis surgeries using the da Vinci Xi system between October 2023 and April 2025.

Results

This study analyzed 108 patients, with 39.8% diagnosed with deep infiltrating endometriosis (DIE). The mean age and body mass index of the study groups were 40.9 ± 6.6 years and 26.3 ± 3.3 kg/m², respectively. The average operative time was 129.8 ± 56.0 minutes, with minimal intraoperative and postoperative complications (0.9% each), no conversions to open surgery, no wound infections, and no re-operations. Subgroup analysis revealed that DIE cases had longer operative times. Though complication rates and post-anesthesia care unit stay remained comparable to the non-DIE subgroup. Both subgroups demonstrated significant improvements in postoperative pain and quality of life scores (p < 0.001) compared to their preoperative values. The risk-adjusted cumulative sum analysis of operative and docking times demonstrated distinct learning phases, with marked improvements in surgical efficiency and operating room workflow over time. Notably, a marked inflection point was observed around case 28 in the DIE subgroup. While this subgroup may represent a particularly suitable cohort for the application of robotic techniques, these findings should be interpreted as reflective of procedural optimization within a carefully selected patient population rather than as a definitive statement of superiority.

Conclusions

This study confirms the feasibility, safety, and effectiveness of RAS for endometriosis in India, with significant postoperative improvements and low complication rates across all stages, including complex DIE cases.