Robot-assisted surgery in gynecology: indications and efficacy

The development of robotic technology has facilitated the application of minimally invasive techniques for complex gynecologic surgery. Some major advantages of robotic surgery are three-dimensional magnification and articulation beyond normal manipulation. It also detects and filters out any tremors in the surgeon's hand movements, so that they are suitable for microsurgery. Compared to laparotomy, robotic gynecological cancer surgery results in improved clinical outcomes and comparable lymph node yields. Radical trachelectomy is an alternative therapy in early cervical cancer in women who wish to retain fertility. Anatomic restriction to the vaginal approach such as lack of pelvic descent is overcome using the robotic technique. This also enables preservation of the uterine vessels and increased precision and visualization during surgery. Robotic and conventional laparoscopic hysterectomy are equivalent regarding surgical and clinical outcomes. Operating times are longer and costs are significantly higher for the robotic procedure. Robotic surgery has the potential to become an enabler for gynecologic minimally invasive surgery, especially suture-intensive operations such as myomectomy. Patients who underwent robot-assisted laparoscopic myomectomy had significantly decreased blood loss, complication rates, and length of stay. The ultimate role of robot-assisted laparoscopic myomectomy is to supplant open myomectomy as the standard of care for conservative surgical treatment of myomas. Robot-assisted treatment of deep infiltrating endometriosis is feasible and safe. Robotic sacrocolpopexy demonstrated similar short-term surgical outcome compared with abdominal sacrocolpopexy, with longer operative time, less blood loss, and a shorter length of stay. Except for its higher cost, robotic surgery in gynecology is feasible with a low complication rate and comparable surgical outcomes.