Updates and Controversies of Robotic-Assisted Surgery in Gynecologic Surgery

Abstract

minimally invasive surgery (MIS) is the standard approach to performance of several gynecologic procedures, including hysterectomy, gynecologic cancer staging procedures, myomectomy, pelvic organ prolapse repair, and select adnexal procedures. Robotic-assisted surgery, a computer-based MIS approach, has been adopted widely in the United States and several other countries. Robotics may offer technological and ergonomic benefits that overcome limitations associated with conventional laparoscopy; however, it is not clear that reported claims of superiority translate into improved gynecologic patient outcomes compared with other MIS approaches. This review critically appraises the evolving role, benefits, limitations, and controversies of robotic-assisted surgery utilization in benign and oncologic gynecology settings.

Comparison between robotic and laparoscopic myomectomy: the introduction of a multi-center observational cohort project

“…Chen et al [19] reported a steep decrease in docking time and console time in the robotic single-site hysterectomy group given chronological change. Although no study has addressed RM's learning curve, we assume it is similar to robotic hysterectomy [20]. Therefore, we assumed 24 cases within 1 year could master the technique needed for RM.…”

Emerging Nano/Micro-Structured Degradable Polymeric Meshes for Pelvic Floor Reconstruction

“…These new ultrasound technologies could enable the development of personalised mesh design based on a CAD generated from these images, thereby taking 3D printing technologies to the next level of sophistication. Computer-assisted robotic surgery [ 163 , 164 ] is already becoming a routine surgical method due to its precision and minimal invasiveness. In future, we envision a personalised mesh, designed using a computer interface integrated with a pelvic ultrasound, that can be implanted using computer-assisted robotic surgery.…”

New Surgical Technique for Robotic Myomectomy: Continuous Locking Suture on Myoma (LSOM) Technique

“…However, the high cost of RALM is a major disadvantage [ 4 , 5 , 6 , 7 , 8 ]. Varghese et al [ 9 ] reported the effectiveness and costs of hysterectomy: the cost of robotic hysterectomies was 1.5–3 times higher than the costs of conventional techniques, including laparoscopic or vaginal approaches [ 9 ]. Tapper et al [ 10 ] also showed that the cost of RALM was consistently higher than the cost of abdominal myomectomy or laparoscopic myomectomy, unless the robotic disposable equipment costs were less than $1400.…”