Review of Robotic Surgery in Gynecology—The Future Is Here

Abstract

The authors present a systematic review of randomized and observational, retrospective and prospective studies to compare between robotic surgery as opposed to laparoscopic, abdominal, and vaginal surgery for the treatment of both benign and malignant gynecologic indications. The comparison focuses on operative times, surgical outcomes, and surgical complications associated with the various surgical techniques. PubMed was the main search engine utilized in search of study data. The review included studies of various designs that included at least 25 women who had undergone robotic gynecologic surgery. Fifty-five studies (42 comparative and 13 non-comparative) met eligibility criteria. After careful analysis, we found that robotic surgery was consistently connected to shorter post-surgical hospitalization when compared to open surgery, a difference less significant when compared to laparoscopic surgery. Also, it seems that robotic surgery is highly feasible in gynecology. There are quite a few inconsistencies regarding operative times and estimated blood loss between the different approaches, though in the majority of studies estimated blood loss was lower in the robotic surgery group. The high variance in operative times resulted from the difference in surgeon’s experience. The decision whether robotic surgery should become mainstream in gynecological surgery or remain another surgical technique in the gynecological surgeon’s toolbox requires quite a few more randomized controlled clinical trials. In any case, in order to bring robotic surgery down to the front row of surgery, training surgeons is by far the most important goal for the next few years.

Is Robotic-Assisted Surgery Safe in the Elderly Population? An Analysis of Gynecologic Procedures in Patients ≥ 65 Years Old

“…23,29–38 The incidence of overall complications in our cohort was much lower (8.2%)—similar to that reported for the general population (approximately 9%) in a recent review and meta-analysis of the literature. 39 , 40 This indicates that robotic surgery in the elderly appears to be feasible, with acceptable morbidity. In our study, we found no increased risk of overall complications within the three age groups examined.…”

“…However, although we observed an unfavorable trend related to age, it is important to emphasize that the overall incidence of adverse events was comparable to that reported in the literature for similar age groups, as well as for the general population. 23 , 29–40…”

Robotic‐assisted surgical procedures are the future of gynaecology in Australasia

“…Robotic myomectomy is more expensive compared to other surgical approaches, a fact restraining its access. Ultimately, randomised clinical trials (RCTs) are urgently needed to support the influx of data regarding the advantages of robotic surgery …”

Robotic Hysterectomy for Cancer and Benign Pathology

“…Over the past 12 years, the da Vinci assisted approach to laparoscopic hysterectomy has taken a more prominent role in the surgical management of a multitude of benign and oncologic gynecologic conditions. Multiple meta-analyses and literature reviews have shown that the use of robotic surgery offers the advantage of decreased blood loss and length of stay when compared to open surgical techniques [5]. When compared to traditional laparoscopic methods outcomes appear to be equivocal, but a case can be made for the advantages of robotic surgery to treat obese patients [6].…”