The benefits and challenges of robotic-assisted hysterectomy

To analyze the recent evidence on robotic hysterectomy while highlighting its benefits and challenges.

Increased rates of robotic hysterectomy have led to decreasing rates of abdominal hysterectomy, after rates of the latter approach have been stagnant for many years. Robotic surgery has also the possible advantage of a relatively short learning curve, even though the case number required to reach proficiency may be actually closer to 100 cases. Recent studies comparing robotic and laparoscopic hysterectomy for benign indications have not demonstrated a clear advantage for either approach in terms of complications, blood loss, and hospital stay. The higher cost of robotic hysterectomy remains a significant disadvantage of this surgical approach, although the total cost may decrease with increasing surgeon's experience (via shorter operative time) and may be offset in some circumstances by reduced hospital stay and cost of complications compared with abdominal hysterectomy.

The place of robotic hysterectomy in the gynecologic surgical armamentarium is still evolving. Although recent studies highlight the comparative outcomes of robotic and laparoscopic hysterectomy for benign cases, most surgeons are unlikely to be equally proficient in both techniques. Future studies will need to question whether subgroups of patients with complex benign disease such as endometriosis and pelvic adhesive disease may benefit from the robotic assistance.