Pioneering a new era in the treatment of deep infiltrating endometriosis through robotic surgery

Surgical treatment of endometriosis is a highly challenging and often controversial area from the perspective of gynecologic surgeons.

The surgical indications vary depending on the extent of disease - from cases confined to ovarian endometriomas to deeply infiltrating lesions involving surrounding organs. There is also considerable debate among surgeons regarding the extent of surgery required. Furthermore, there are ongoing discussions about whether surgery should be replaced or complemented by medical therapy.

The purpose of surgery can also differ: whether it's for symptom relief, differentiation from malignancy, or maximal excision of lesions, each objective results in a different surgical approach. When the goal is maximal excision of lesions, access to the retroperitoneum becomes essential, requiring in-depth knowledge and experience in handling the ureters, nerves, and blood vessels.

Robotic surgery is considered the most ideal approach for such complex cases, and for this reason, the Society of Korean Robotic Gynecologic Surgery has organized a special workshop on deep infiltrating endometriosis (DIE).

The Society of Korean Robotic Gynecologic Surgery and the Pelvic Nerve Study Group jointly hosted a special workshop on August 31, 2025. This workshop, titled “Deep Infiltrating Endometriosis, Nerve and Surgical Innovation”, was organized to share practical techniques and insights that can be directly applied in clinical practice.

A key focus was the essential neuroanatomical understanding required for DIE surgery, including lectures on the concept of neuropelviology and the distinction between autonomic and somatic nerves. The program also covered radiological approaches, including ultrasound and magnetic resonance imaging findings for DIE, and offered in-depth discussions on surgical strategies.

Moreover, through the clinical experiences of leading domestic experts, participants gained practical guidance on laparoscopic and robotic surgical approaches for various intra-abdominal DIE lesions, as well as postoperative management strategies.

Finally, there was a valuable session featuring professor Marc Possover, where participants had the rare opportunity to learn and discuss the pelvic nerve research achievements he has dedicated his life to - such as Laparoscopic Neuro-Navigation (LANN) and Laparoscopic Implantation of Neuroprosthesis (LION) procedures.

For patients living with DIE, the future looks more hopeful than ever. Robotic surgery is not merely an addition to our surgical armamentarium. It is a transformative tool that may redefine the standard of care in endometriosis management.