Review Article
Systematic Review of Robotic Surgery in Gynecology: Robotic Techniques Compared With Laparoscopy and Laparotomy

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Abstract

The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability.

Section snippets

Sources

Eleven members of the SGS SRG, which includes gynecologic surgeons and systematic review methodologists, performed a systematic search to identify studies of robotic-assisted laparoscopic gynecologic surgery. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies, using the search terms “Aesop,” “computer assisted,” “computer motion,” “da Vinci,” “gynecology,” “intuitive,” “robotics,” “surgery,” and “Zeus,” as

Study Selection

Abstracts were independently screened in duplicate using the computerized screening program abstrackr (Tufts Medical Center, Boston, MA) [2] with the following eligibility criteria: study participants were all women who had undergone robotic-assisted laparoscopic gynecologic surgery, and the studies evaluated robotic-assisted laparoscopic surgery. We included RCTs, prospective and retrospective comparative observational studies, and case-control studies of robotic-assisted vs nonrobotic

Results

The literature search yielded 1213 citations, of which 97 full-text articles were retrieved and rescreened. Of these, 30 comparative studies met eligibility criteria and were analyzed in the systematic review. Fourteen additional noncomparative articles were eligible for analysis of adverse events (Fig. 1).

Described are the clinical and associated outcomes from comparative studies, categorized according to the indications for surgery: surgical management of endometrial cancer (13 studies),

Discussion

The SGS SRG sought to summarize the available literature about robotics in gynecologic surgery and ultimately to develop a clinical practice guideline to help guide adoption of this new technology. However, the dearth of high-quality data precluded our group’s ability to develop meaningful recommendations. Although the available literature suggests that robotic and laparoscopic techniques seem to be no different for many outcomes, there is compelling evidence that robotics has advantages over

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    The Society of Gynecologic Surgeons provided funding for assistance by methods experts in systematic review and logistic support.

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