Introduction. Robot-assisted surgery has become more widespread in gynecological oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment. Material and methods. A database search in PubMed and EMBASE was performed up until 4 March 2016. The search strategy was developed in collaboration with an information specialist, and by application of the PRISMA guidelines. Human participants and English language were the only restrictive filters applied. Selection was performed by screening of titles and abstracts, and by full text scrutiny. From 2001 to 2016, a total of 76 references were included. Results. Robot-assisted surgery in gynecological oncology has increased, and current knowledge supports that the oncological safety is similar, compared with previous surgical methods. Controversies arise because current knowledge does not clearly document the benefit of robot-assisted surgery, on perioperative outcome compared with the increased costs of the acquisition and application. Conclusions. The rapid development in robot-assisted surgery calls for long-term detailed prospective cohorts or randomized controlled trials. The costs associated with acquisition, application, and maintenance have an unfavorable impact on cost-benefit evaluations, especially when compared with laparoscopy. Future developments in robot-assisted surgery will hopefully lead to competition in the market, which will decrease costs.

What are the novel findings of this work?Even small errors in the first-trimester measurement of crown-rump length (CRL) significantly affect secondand third-trimester estimated fetal weight (EFW). A measurement error of −2 mm in first-trimester CRL shifts an EFW on the 10 th percentile at the 20-week scan to around the 20 th percentile. A measurement error of + 2 mm shifts an EFW on the 10 th percentile to around the 5 th percentile. What are the clinical implications of this work?Published data suggest that CRL measurement errors of 2 mm or more are common in clinical practice. Misclassification as small-, appropriate-or large-for-gestational age will commonly occur and affect clinical assessment, patient management and research results. Thus, there is a need to increase awareness of the importance of correct CRL measurement and to reduce measurement error variation through standardization and quality control.

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