Robotic-assisted hysterectomy for endometrial cancer

Robotic-assisted surgery (RAS) has revolutionized the treatment of endometrial cancer (EC), providing a less invasive alternative to traditional open methods. In early-stage EC, RAS has shown similar oncological results compared to conventional techniques while offering notable improvements in perioperative outcomes, such as shorter hospital stays, less post-operative pain, and faster recovery times. Additionally, the robotic platform has seen widespread adoption in gynecologic oncology due to its ability to address the limitations of conventional laparoscopy, especially reduced conversion rate from minimally invasive surgery (MIS) to open/laparotomy. This approach is particularly beneficial for high-risk groups, including obese and elderly patients, where it has proven to be both safe and effective, presenting a favorable risk-benefit profile. Furthermore, robotic-assisted sentinel lymph node (SLN) mapping, utilizing the FireFly^® fluorescence imaging system with indocyanine green (ICG) dye, offers exceptional accuracy in detecting SLNs, enhancing the precision of nodal mapping, thereby decreasing the need for more invasive lymphadenectomy and reducing associated morbidity. It is essential to recognize physiological challenges that can arise during RAS, particularly when steep Trendelenburg position combined with pneumoperitoneum (increased intra-abdominal pressure due to CO2 insufflation), can significantly affect both cardiovascular and respiratory systems. Although the upfront costs of robotic surgery are relatively higher, the long-term benefits, such as fewer complications and faster recoveries, make it a cost-effective solution. This review examines current evidence supporting the use of RAS as a standard option for managing patients with EC and its positive impact on their outcomes across diverse risk categories.