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Robot-assisted surgery in gynaecology.

Hongqian Liu1, Theresa A Lawrie, DongHao Lu

  • 1Department of Obstetrics and Gynecology,West China Second University Hospital, Sichuan University, Chengdu, China.

The Cochrane Database of Systematic Reviews
|December 11, 2014
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Summary

Robot-assisted surgery (RAS) for gynecological procedures shows similar complication rates to conventional laparoscopic surgery (CLS), but takes longer. RAS may reduce hospital stays for hysterectomy, but more research is needed for gynecological cancer treatment.

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Area of Science:

  • Gynecological Surgery
  • Minimally Invasive Procedures
  • Surgical Technology

Background:

  • Robot-assisted surgery (RAS) is a novel laparoscopic technique.
  • Its effectiveness and safety compared to conventional laparoscopic surgery (CLS) require evaluation for benign and malignant gynecological conditions.
  • Previous reviews on RAS for benign and malignant gynecological disease have been merged for an updated analysis.

Purpose of the Study:

  • To evaluate the effectiveness and safety of RAS versus CLS in women undergoing gynecological surgery.
  • To synthesize evidence from randomized controlled trials (RCTs) comparing RAS with CLS or open surgery.

Main Methods:

  • Searched Cochrane CENTRAL, Gynaecological Cancer Review Group Register, MEDLINE, and EMBASE databases up to June 2014.
  • Included RCTs comparing RAS with CLS or open surgery for gynecological disease.
  • Two reviewers independently assessed study inclusion, risk of bias, and extracted data; pooled data using random-effects methods.

Main Results:

  • Six RCTs with 517 women were included, primarily for hysterectomy and sacrocolpopexy.
  • No significant difference in intraoperative or postoperative complications between RAS and CLS (low to moderate quality evidence).
  • RAS procedures were longer by ~42 minutes, but hospital stay was shorter by ~7 hours for hysterectomy (moderate to low quality evidence).

Conclusions:

  • Uncertainty remains regarding complication rates due to imprecision and inconsistency in studies for hysterectomy and sacrocolpopexy.
  • RAS may offer shorter hospital stays for hysterectomy but requires longer operating times.
  • Limited evidence exists for RAS in gynecological cancer surgery; use should be restricted to clinical trials.