Computer assisted reproductive surgery Why it matters to reproductive endocrinology and infertility subspecialists

Fertility specialists are uniquely trained to establish the indications and extent of reproductive surgery. Modern reproductive surgery is minimally invasive and complex. Computer assistance can promote subspecialists’ involvement in reproductive surgery.

Antonio R. Gargiulo, M.D.

Volume 102, Issue 4, Pages 911-921


Trained fertility specialists possess a unique clinical perspective and an extensive medical and technological armamentarium to overcome reproductive dysfunction: it is their privilege and ethical duty to lead the field of reproductive surgery. However, modern reproductive surgery can no longer exist outside of the realm of advanced laparoscopy. This has been a major hurdle to the thriving of surgery within our subspecialty, owing to the time and effort required to achieve and maintain proficiency in the antiergonomic environment of conventional laparoscopy. Computer-assisted surgery minimizes aptitudinal restrictions to the adoption of advanced laparoscopy. As such, it promotes strategy over technique and may hold the key to the continued success of high-specialty reproductive surgery.

  • Micah Hill

    Thank you for the great review article! When I was a resident, our REI physicians were our surgical experts and consulted into the OR for difficult endometriosis and other cases. Over a very short period of time, this has rapidly shifted to the MIS and GYN ONC domain. I echo your call for REI physicians to retain expertise in our surgical areas!

    I asked Dr Falcone on this forum and would ask you the same question. We have 1-2 robotic ORs per week for REI at our hospital and most commonly use them for tubal reanastomosis. I have wanting to take advantage of this by performing a RCT for mini-lap microscope versus robotic BTA. Do you have additional questions about robotic BTA which you think could be well addressed in an RCT?

    • Antonio Gargiulo

      Dear Dr. Hill: Thank you for your comment. Of course an RTC of this kind would have merit in itself, as this kind of study has not been done. It sounds like your practice may have unique conditions for this to take place outside of the robotic learning curve, which would be essential for this advanced operation.
      Personally, I would standardize the procedure so that an identical procedure is performed open vs. robotic. I would also standardize the preoperative requirements (maximum age, minimum semen parameters, baseline FSH/E2/AMH, sonohysterogram). I would include a total hospital cost analysis in this assessment: I have never kept a patient over 6 hours for a robotic tubal reanastomosis. Provided your minilaps stay overnight, you have a shot at a competitive cost on the robot side. Otherwise not. If you are training fellows if would be interesting to time their complete reanastomosis times and follow their patency rates at HSG.

      • Micah Hill

        Those are great thoughts! We do train fellows and that would be very interesting to track times and results. Thank you for the reply!

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