**2.7. Is there a role for robotic surgery in improving pregnancy rate?**

Among experienced endoscopists, it's well known that it's not the robot that does the surgery, it's the surgeon!

In a retrospective study, both robotically-assisted laparoscopic and standard laparoscopic treatments of endometriosis had excellent outcomes. The robotic technique required significantly longer surgical and anesthesia time, as well as larger trocars (6).


Endoscopy versus IVF: The Way to Go 31

 Severity of the tubal disease. Duration of subfertility.

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

**2.10. Laparoscopy and IVF/ICSI are complementary since a long time (9)** 

The first in vitro fertilization (IVF) child ensued following the partnership by a scientist with a focused ambition (Nobel laureate Robert Edwards) joining with the gynecologist who introduced laparoscopy to Britain in the late 60's (Patrick Steptoe). Egg retrieval was done laparoscopically. In modern practice, laparoscopic egg retrieval is still required whenever inaccessible ovaries are encountered. A trial of transabdominal sonographic aspiration was recently published with lower success rate of egg retrieval if compared to transvaginal

**Laparoscopic GIFT:** a blastocyst intrafallopian transfer was associated with an intrauterine pregnancy; however, when the indication for blastocyst tubal transfer of an obstructed cervix is associated with a foreshortened cervix requiring cervical cerclage, there can be

Always try to use the appropriate approach for a suitable couple at the appropriate time. To achieve the best results, try to stratify the lines of management according to pathology putting in mind other circumstances. The following are examples of how to think in each

The optimal management of endometriotic ovarian cysts in infertile patients is less well defined. Recent evidence of reduced responsiveness to gonadotrophins following

**3. Pelvic endometriosis: A good example of how to individualize** 

Maternal age.

instrumentation.

sonographic aspiration (10).

major health risks for infant and mother (11).

**2.11. What's the best approach?** 

case separately.

**treatment** 

**Figure 1.** Robotic surgery in Gynecology
