The future of robotic‐assisted laparoscopic gynaecologic surgery in Australia – A time and a place for everything

Abstract

There has been a significant increase in minimally invasive surgery in gynaecology over the last 15 years, with approximately only one-third of hysterectomies for benign disease now performed via laparotomy. While robotic surgery offers considerable technical advantages over conventional laparoscopy and is associated with only a modest learning curve, the improvement in clinical outcomes is marginal and there are several disadvantages. There are increased set-up and operating times, the need to accommodate and maintain large sophisticated equipment, and the requirement for additional training. The preeminent issue regarding the place of robotic gynaecological surgery is cost. How this is addressed and contained will ultimately determine uptake in Australia. From the published literature to date, robotic surgery compared with conventional laparoscopic surgery is associated with marginal improvements in clinical outcomes for benign hysterectomy and endometrial cancer surgery, but little improvement for other benign gynaecological surgery or for cervical cancer surgery. Robotic surgery probably does improve clinical outcomes in obese and morbidly obese patients and is associated with improved ergonomics for the surgeon. It is likely that there will be continued substantial improvements in robotic surgical platforms into the foreseeable future and that robotic surgery will play an increasingly important role in gynaecological surgery in Australia.

Outcomes in women undergoing robotic‐assisted laparoscopic hysterectomy compared to conventional laparoscopic hysterectomy at a tertiary hospital in Western Australia

“…4 However, in women with benign disease, RALH has not been shown to improve outcomes and is associated with longer operating times and higher cost compared to TLH. 5 The American…”

A laparoscopic study investigating 3D vs 2D imaging systems using a pelvitrainer model with experts, non-experts, and students

“…However, the combination of 3D and conventional LSC offers a more cost-effective and simpler alternative to the Da Vinci [16,17]. Yet, this technology is still in the developmental phase, thus our work should be seen as a contribution to help move this technology forward [11,18,19,20].…”

Quality of life in patients who undergo conventional or robotic-assisted total laparoscopic hysterectomy

“…Abdominal hysterectomy (known as laparotomy) involves removal of the uterus through a low abdominal incision. [11] Vaginal hysterectomy involves removal of the uterus through the vagina without an abdominal incision. Laparoscopic hysterectomy is performed through small incisions in the abdomen, with the uterus removed through the vagina or one of the small abdominal incisions after morcellation (fragmentation).…”

“…To make well-informed decisions, women who need to undergo hysterectomy for benign disease need to know the risks and benefits of each surgical approach. [11,12] …”