Surgical and Patient Outcomes of Robotic Versus Conventional Laparoscopic Hysterectomy: A Systematic Review

Abstract

Hysterectomy is a commonly performed gynecologic surgery that can be associated with significant morbidity and mortality. However, the evolution of the surgical approach, from open to minimally invasive gynecologic surgery (MIGS), has substantially improved patient outcomes by reducing perioperative complications, pain, and length of hospitalization. The evident advantages and the approval of the da Vinci Surgical System by the Food and Drug Administration led to the exponential rise in the use of MIGS. In particular, robotic hysterectomy (RH) witnessed unparalleled popularity compared to other MIGS despite the lack of strong evidence demonstrating its superiority. Therefore, we conducted a systematic review of the literature to evaluate and compare various patient and surgical outcomes of RH with conventional laparoscopic hysterectomy (CLH), including operating time, estimated blood loss, length of hospitalization, overall complications, survival, and cost. Overall, the outcomes were comparable between RH and CLH except concerning cost. RH is significantly more expensive than CLH due to the higher costs of robotic equipment, including disposable instruments, equipment maintenance, and sterilization. Although RH demonstrated comparable outcomes and higher costs, its technical advantages such as improved ergonomics, three-dimensional view, a wider range of wristed mobility, mechanical lifting of robot's hand, and greater stability might benefit patient subsets (e.g., obesity, large uterine weights >750 g). Therefore, large and multicentered randomized control trials are imperative to determine the most effective surgical approach between RH and other MIGS for different patient subsets.

Comparison of postoperative analgesia use between robotic and laparoscopic total hysterectomy: a retrospective cohort study

“…One reason is that robotic surgery may result in less postoperative pain due to using more stable trocars. Previous reports have suggested that robotic surgery, where the trocar is stable at the abdominal wall, may cause less postoperative pain than laparoscopic surgery as trauma to the abdominal wall is reflected in postoperative pain [8,9]. Also, since this study had a small sample size, it may be possible to detect differences in the percentage of postoperative analgesic use between robotic…”

“…This study showed no significant difference in postoperative pain between robot-assisted and laparoscopic total hysterectomy when non-opioid pain management involving NSAIDs and acetaminophen was used. Since robotic surgery is more expensive than laparoscopic surgery [9], it is reasonable to select laparoscopic surgery as an option for minimally invasive total hysterectomy. In addition, a new postoperative pain assessment item, postoperative analgesics, was used in this study, and patients did not require analgesics even when the numerical rating scale (NRS) score was 4-6, suggesting that the interpretation of the NRS may differ between providers and patients [10].…”

Comparison of Postoperative Analgesia Use Between Robotic and Laparoscopic Total Hysterectomy: A Retrospective Cohort Study

“…Previous reports have suggested that robotic surgery, where the trocar is stable at the abdominal wall, may cause less postoperative pain than laparoscopic surgery as trauma to the abdominal wall is re ected in postoperative pain [8,9]. Also, since this study had a small sample size, it may be possible to detect differences in the percentage of postoperative analgesic use between robotic and laparoscopic total hysterectomy by studying a larger sample size.…”

“…This study showed no signi cant difference in postoperative pain between robot-assisted and laparoscopic total hysterectomy when non-opioid pain management involving NSAIDs and acetaminophen was used. Since robotic surgery is more expensive than laparoscopic surgery [9], it is reasonable to select laparoscopic surgery as an option for minimally invasive total hysterectomy. In addition, a new postoperative pain assessment item, postoperative analgesics, was used in this study, and patients did not require analgesics even when the numerical rating scale (NRS) score was 4-6, suggesting that the interpretation of the NRS may differ between providers and patients [10].…”

Prevention and management of vaginal cuff dehiscence: an updated review

“…Despite the estimated rates of VCD being higher for TLH, including robotic-assisted TLH (RATLH), there are clear benefits to minimally invasive hysterectomies – decreased perioperative complications, decreased blood loss, decreased pain, faster recovery, shorter hospitalization time, and improved patient satisfaction [5,20 ▪ ,21 ▪ ,22 ▪ ]. As VCD is rare overall, the most minimally invasive approach appropriate for the patient should be the chosen method.…”