Robot-assisted surgery in gynaecology.

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Procedures
• Surgical Technology Assessment

Background:

• Robot-assisted surgery (RAS) is an innovation in laparoscopic surgery, allowing surgeons to operate from a console.
• RAS is increasingly used for hysterectomy and other gynecological procedures, but its effectiveness and safety compared to conventional laparoscopic surgery (CLS) require clear establishment.
• This review merges two previous Cochrane reviews on RAS for benign and malignant gynecological diseases.

Purpose of the Study:

• To assess the effectiveness and safety of robot-assisted surgery (RAS) compared to conventional laparoscopic surgery (CLS) or open surgery for women with benign and malignant gynecological disease.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) comparing RAS with CLS or open surgery for gynecological conditions.
• Searches conducted in CENTRAL, MEDLINE, EMBASE, and ClinicalTrials.gov up to January 2018.
• Data extraction and risk of bias assessment by two independent reviewers; meta-analysis using random-effects models where appropriate.

Main Results:

• Twelve RCTs involving 1016 women were included, with moderate to high risk of bias.
• For hysterectomy (benign and malignant), low-certainty evidence suggests similar complication rates between RAS and CLS, but RAS may increase operating time.
• For sacrocolpopexy, low-certainty evidence suggests similar overall complication rates but potentially higher postoperative complications with RAS; operating time may increase.

Conclusions:

• Evidence for RAS in non-malignant gynecological conditions (hysterectomy, sacrocolpopexy) is of low certainty, suggesting comparable surgical complication rates to CLS.
• Evidence for RAS in malignant gynecological conditions is more uncertain due to a lack of survival data.
• RAS is an expensive, operator-dependent technology, posing challenges for independent safety evaluation.