The role of robotic surgery in gynecology

To discuss the recent experience and feasibility of integrating robot-assisted technology into minimally invasive gynecologic surgery. Current applications in gynecology and their associated outcomes will be analyzed.

Since the late 1990s, the use of computer-assisted or robotic technology in minimally invasive gynecologic surgery has increased. Much of this experience revolves around the da Vinci surgical system, which was approved by the Food and Drug Administration for gynecologic applications in April 2005. The largest body of experience exists with robot-assisted laparoscopic hysterectomy, particularly those classified as American Association of Gynecologic Laparoscopists type IVE or Laparoscopic Supracervical Hysterectomy III. Other notable applications are in the areas of myomectomy, tubal reanastomosis, sacrocolpopexy, and cancer staging. Advantages of the robotic approach are the improved dexterity and precision of the instruments coupled with three-dimensional imaging. Limitations include the absence of haptic (tactile) feedback, bulkiness of the system, lack of vaginal access, and cost.

Current evidence demonstrates the safety and feasibility of the robotic approach for gynecologic surgery. Experience is still in its infancy, however, and prospective trials are needed to compare the efficacy against conventional laparoscopy and to help determine not only who should be doing robotic-assisted surgery but also for which applications.