Robotic Versus Laparoscopic Surgery for Colorectal Endometriosis: A Systematic Review and Meta-Analysis of Comparative Observational Cohorts

This review compares perioperative and selected postoperative outcomes between robotic-assisted surgery and conventional laparoscopy in females undergoing surgical treatment for colorectal or rectosigmoid endometriosis.This systematic review and meta-analysis followed the PRISMA 2020 guidelines.PubMed, Web of Science, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and African Journals Online (AJOL) were searched from January 2020 to August 2026 for comparative observational studies evaluating robotic-assisted versus conventional laparoscopic surgery specifically for colorectal or rectosigmoid endometriosis.Manual bibliographic searches of the reference lists of relevant articles were also conducted to identify additional eligible studies.Studies involving general, superficial, ovarian, or deep endometriosis without separately identifiable colorectal disease were excluded.Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers, with disagreements resolved by discussion.Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), and random-effects meta-analysis was undertaken only for outcomes with sufficiently comparable and non-duplicated data.Eight comparative observational reports met the eligibility criteria.Across studies reporting operative duration, robotic-assisted surgery was generally associated with longer operative time than conventional laparoscopy, although the magnitude and statistical significance of this difference varied between cohorts.Estimated blood loss, overall postoperative complications, conversion to open surgery, and most other perioperative outcomes were broadly comparable between approaches.Length of hospital stay showed inconsistent findings across studies, while selected reports suggested possible differences in voiding dysfunction, reoperation, recurrence, postoperative opioid use, and other longer-term outcomes.Considerable clinical and methodological heterogeneity was present because of differences in colorectal lesion complexity, extent of bowel surgery, associated pelvic procedures, institutional experience, follow-up duration, and outcome definitions.Potential overlap between several reports from the same specialist centre was addressed at the outcome level to avoid duplicate contribution of participants to pooled estimates.Overall, robotic-assisted surgery appears to be a feasible alternative to conventional laparoscopy for colorectal endometriosis, but current evidence does not demonstrate a consistent perioperative superiority of either approach.Because all available evidence is observational and susceptible to selection bias, residual confounding, temporal effects, and cohort overlap, causal conclusions cannot be drawn.Further prospective, multicentre, independently recruited comparative studies with standardized perioperative and long-term outcome reporting are required.