**2.9. Which approach should we use: expectant, endoscopy or ART? (8)**

The treatment choice depends upon:


**Table 2.** Pros and cons of Robotic surgery

**Figure 1.** Robotic surgery in Gynecology

**2.8. Can IVF replace endoscopy?** 

The treatment choice depends upon:

surgery and should be offered as a first-line treatment (7).

Three-D vision

The dexterity (ability to bend at the "wrist") of the robotic instruments makes it possible to perform some surgeries laparoscopically that would otherwise require laparotomy.

Myth Facts

The surgeon sees up to 30% more endometriosis. No RCT

Rapid recovery and smooth postop course No RCT

Due to advances in the field of IVF/ICSI and stratification of management plans worldwide, the overall pregnancy rate following IVF/ICSI overcame that following endoscopic surgery in many centers. These encouraging results made some authors consider ART superior to

**2.9. Which approach should we use: expectant, endoscopy or ART? (8)** 

Less recurrence and slowly No RCT

no demonstration that it increasesspeed or safety

this point is debated among experts.

Coexisting infertility factors.

Despite the widespread utilization of assisted reproductive techniques in recent years, hysteroscopic as well as laparoscopic surgery should be firstly offered for patients with adnexal and uterine lesions desiring fertility. Permanent correction of the patient's problem with frequent chances of pregnancy is a definite advantage of endoscopic surgery over assisted reproductive techniques. Reconstructive endoscopic procedures could be performed for fertile women as well e.g. hysteroscopic or laparoscopic myomectomy for abnormal bleeding. The concept of reconstruction following microsurgical principles coupled with refinement of instrumentation and techniques is would improve the results of hysteroscopic and laparoscopic approaches. It is expected to expand to cover many gynecologic aspects in the coming years particularly with the continuous advances in technology of fine endoscopic surgery and the development of more suitable robotic instrumentation.
