Being thorough Is More Important Than Being Fast in Endometriosis Surgery

Surgical duration reflects disease severity, not increased risk.

Key Points

Highlights: 

• Longer surgical times were not associated with increased postoperative complications in patients undergoing minimally invasive surgery for stage III–IV endometriosis.
• Extended operative durations were linked to a higher likelihood of overnight hospital admission, but not to higher morbidity.
• Thorough and meticulous surgery should be prioritized over speed in complex endometriosis cases.

Importance:

• Operative duration alone does not determine safety in advanced endometriosis surgery.
• Comprehensive lesion excision may require longer operating times but does not compromise postoperative outcomes, emphasizing the importance of surgical completeness and expertise over time efficiency.

What’s done here:

• This was a retrospective cohort study including 583 women who underwent minimally invasive surgery for stage III–IV endometriosis between 2013 and 2023.
• Intraoperative and postoperative complications across the 50th, 75th, and 90th percentile thresholds of surgical time were analyzed to evaluate the association between operative duration and surgical safety.

Key results:  

• Longer surgical time correlated with more intraoperative complications at the median threshold, but not with postoperative complications at higher percentiles.
• No significant association was found between surgical time (median, 90th percentile, or per additional hour) and postoperative complication rates.
• Each additional hour of surgery increased the odds of overnight hospital admission by 64%.
• Surgical times above the 75th percentile may even correspond to a trend toward lower postoperative complication rates, possibly reflecting more thorough disease clearance.

Limitations:

• The study’s retrospective single-center design introduces potential selection bias and confounding factors.
• Findings may not generalize to lower-volume centers or less specialized surgical teams.
• The low overall complication rate limits statistical power, and long-term outcomes such as recurrence, pain, or fertility were not assessed.

From the Editor-in-Chief – EndoNews

"In advanced endometriosis surgery, efficiency should never be mistaken for excellence. This study provides an important quantitative confirmation of what experienced surgeons intuitively understand: the quality of surgical dissection, not the speed of completion, determines patient safety and outcome.

By analyzing more than 500 stage III–IV cases, the authors show that longer procedures do not translate into more complications, provided the surgery is performed in specialized centers with experienced teams. The only measurable consequence of extended operating time was an increased likelihood of overnight hospital stay — a logistical rather than a clinical issue.

These findings underscore a crucial principle in minimally invasive gynecologic surgery: time is a reflection of disease complexity and surgical thoroughness, not a measure of inefficiency. Rushed excision of deep lesions or incomplete hemostasis may shorten the procedure but compromise long-term outcomes. A careful, stepwise approach is essential to reduce recurrence, preserve organ function, and restore quality of life.

The message extends beyond the operating room. In training and policy discussions, operative time should not be used as a performance metric when evaluating complex endometriosis surgery. Instead, emphasis should be placed on completeness of disease removal, multidisciplinary support, and long-term patient recovery.

This study reinforces that, in expert hands, patience is precision — and precision is safety."

Lay Summary

Longer surgical times are not associated with a higher risk of short-term postoperative complications in patients with stage 3 or 4 endometriosis undergoing minimally invasive surgery, according to a new study published in BMC Women’s Health.

However, longer procedures were independently linked to a higher likelihood of overnight hospital admission. “These findings underscore the need to prioritize surgical thoroughness over speed in complex endometriosis cases,” the authors of the study concluded.

The research team led by Dr. Raanan Meyer from the Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center in LA and The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, in Ramat-Gan, Israel, retrospectively analyzed 583 patients, ages 18 to 51 undergoing minmally invasive surgery surgery for stage 3-4 endometriosis fom 2013 to 2023.

The investigators analyzed the possible link between surgical duration and short-term postoperative complications, as well as between surgical duration and overnight hospital admission. 

At the 50th percentile threshold, longer surgical times were associated with a higher rate of intraoperative complications. However, postoperative complication rates did not significantly differ across the 50th, 75th, or 90th percentile thresholds.

Multivariable regression showed that longer surgeries—whether exceeding the median, 90th percentile, or per additional hour—were not associated with higher postoperative risk. In fact, operative times above the 75th percentile were associated with a potential reduction in postsurgical complications. Each additional hour of surgery was linked to a 64% increase in the likelihood of overnight hospital admission.

Research Source: https://pubmed.ncbi.nlm.nih.gov/41094630/