Abstract
Objective
Following the publication of several high quality randomized controlled trials regarding
the comparison of similar laparoscopic gynecologic procedures being performed with
or without robotic assistance, we aimed to perform a systematic review to identify
any differences in patient safety and expected incidence of complications in these
procedures.
Data Sources
Articles on ClinicalTrials.Gov, Embase, MEDLINE, PubMed, Scopus, and Web of Science
databases were retrieved and screened for eligibility up to April 1st 2021.
Methods of Study Selection
In addition to meeting our screening algorithm, we included studies that met all the
following: randomized control trials (RCT), enrolling patients for indicated laparoscopic
gynecologic procedures, and comparing Robotic Surgery (RS) with Laparoscopic Surgery
(LS) in terms of safety or complications.
Tabulation, Integration, and Results
Data was pooled as mean difference (MD) or risk ratio (RR) with a 95% confidence interval
(CI). Ultimately, six studies were included in this meta-analysis. Pooled data revealed that RS and LS have similar risk for intraoperative
complications (RR = 0.87; 95% CI [0.23, 3.36], P = 0.84), postoperative complications
(RR = 1.07; 95% CI [0.57, 2.01], P = 0.83), significant intraoperative hemorrhage
(RR = 1.40; 95% CI [0.59, 3.34], P = 0.44), postoperative hemorrhage (RR = 0.43; 95%
CI [0.15, 1.22], P = 0.11), vaginal cuff dehiscence (RR = 1.13; 95% CI [0.24, 5.41],
P = 0.88), postoperative wound infection, urinary tract infection, and urinary bladder
or ureteral injury. RS had “surgeon declared” lower estimated blood loss (MD = 85.27;
95% CI [46.45, 124.09], P < 0.00001) and shorter postoperative hospital stay (MD = 1.20;
95% CI [0.38, 2.01], P = 0.004).
Conclusion
There was a statistically significant decrease in hospital stay and “surgeon declared”
blood loss seen in the RS group. There was no statistically significant increase in
risk of developing other postoperative complications between the LS and R groups.
Keywords
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References
- Advantages of robotics in benign gynecologic surgery.Curr Opin Obstet Gynecol. 2016; 28: 304-310
- Effect of surgeon's experience on complications from laparoscopic hysterectomy.Journal of gynecology obstetrics and human reproduction. 2018; 47: 63-67
Kelley WE Jr. The evolution of laparoscopy and the revolution in surgery in the decade of the 1990s. JSLS. 2008 Oct-Dec;12(4):351-7. PMID: 19275847; PMCID: PMC3016007.
- From illusion to reality: a brief history of robotic surgery.Surgical innovation. 2018; 25: 291-296
- Robotic platforms for endometrial cancer treatment: review of the literature.Minerva Med. 2021; 112: 47-54
- Robotic Assisted Laparoscopic Hysterectomy.Emerging Technologies in Women's Health-Robotic Surgery in Gynecology. 2011; 19: 27
- Route of Hysterectomy:“Straight-Stick” Laparoscopy.Journal of Gynecologic Surgery. 2021; 37: 107-111
- Incidence of trocar site herniation following robotic gynecologic surgery.Gynecol Oncol. 2013; 131: 400-403
- Robot-assisted laparoscopy in benign gynecology: advantageous device or controversial gimmick?.Best Practice & Research Clinical Obstetrics & Gynaecology. 2017; 1: 2-6
- Review of robotic surgery in gynecology—the future is here.Rambam Maimonides medical journal. 2017; 8
- Robot-assisted surgery in gynecology.Journal of the Korean Medical Association/Taehan Uisa Hyophoe Chi. 2019; (Apr 1;62(4))
Desai PH, Gillentine RJ. Present Challenges of Robotics in Gynecology. InMedical Robotics 2021 Mar 14. IntechOpen.
- Ergonomics in gynecologic surgery.Curr Opin Obstet Gynecol. 2018; 30: 432-440
- An interdisciplinary team-training protocol for robotic gynecologic surgery improves operating time and costs: analysis of a 4-year experience in a university hospital setting.Journal of Robotic Surgery. 2021; 19: 1-8
- Ergonomics in laparoscopic surgery.J Minim Access Surg. 2010; 6: 31-36https://doi.org/10.4103/0972-9941.65161
- Robotic surgery in gynecology.J Minim Access Surg. 2015; 11: 50-59https://doi.org/10.4103/0972-9941.147690
- Ergonomic Problems Associated with laparoscopy.J Endourol. 2001; 15: 499-503
Nicholas Stylopoulos, David Rattner, Robotics and ergonomics,Surgical Clinics of North America, Volume 83, Issue 6,2003,Pages 1321-1337,ISSN 0039-6109, https://doi.org/10.1016/S0039-6109(03)00161-0.
Advincula AP, Reynolds RK. The use of robot-assisted laparoscopic hysterectomy in the patient with a scarred or obliterated anterior cul-de-sac. JSLS : Journal of the Society of Laparoendoscopic Surgeons.9(3):287-91.
- A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: A case-matched controlled study of the first o.Gynecol Oncol. 2011; 120: 413-418
- Implementing robotic surgery to gynecologic oncology: the first 300 operations performed at a tertiary hospital.Acta Obstet Gynecol Scand. 2015; 94: 482-488
- Perioperative complications of robot-assisted laparoscopic surgery using three robotic arms at a single institution.Yonsei Med J. 2015; 56: 474https://doi.org/10.3349/ymj.2015.56.2.474
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6e1000097
- Cochrane handbook for systematic reviews of interventions.Wiley, Hoboken2019
- Cochrane Handbook: Cochrane Reviews: Ch 8: Assessing risk of bias in included studies.Cochrane handbook for: systematic reviews of interventions. 2011; 1: 3-10
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- A randomized trial comparing vaginal and laparoscopic hysterectomy vs robot-assisted hysterectomy.J Minim Invasive Gynecol. 2015; 22: 78-86
M.M. Maenpaa K. Nieminen E.I. Tomas M. Laurila T.H. Luukkaala J.U. Maenpaa Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial Am J Obstet Gynecol. 2016;215(5):588 e1 e7
- Total laparoscopic hysterectomy with and without robotic assistance: a prospective controlled study.Surg Innov. 2014; 21: 250-255
- Severe perioperative morbidity after robot-assisted versus conventional laparoscopy in gynecologic oncology: Results of the randomized ROBOGYN-1004 trial.Gynecol Oncol. 2020; 158: 382-389
- Robot-assisted laparoscopic radical hysterectomy: comparison with total laparoscopic hysterectomy and abdominal radical hysterectomy; one surgeon's experience at the Norwegian Radium Hospital.Gynecol Oncol. 2011; 121: 600-604
- Robotic-assisted versus conventional laparoscopic hysterectomy for endometrial cancer.Eur J Obstet Gynecol Reprod Biol X. 2020; 8: 100116https://doi.org/10.1016/j.eurox.2020.100116
- Efficacy and safety outcomes of robotic radical hysterectomy in Chinese older women with cervical cancer compared with laparoscopic radical hysterectomy.BMC Womens Health. 2018; 18: 61
- What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman?.Gynecol Oncol. 2008; 111: 41-45
- Robotic versus laparoscopic hysterectomy in morbidly obese women for endometrial cancer.Journal of Robotic Surgery. 2020;
- Total Laparoscopic Hysterectomy With and Without Robotic Assistance.Surgical Innovation. 2014; 21: 250-255
- Comparison of Robotic and Laparoscopic Hysterectomy for Benign Gynecologic Disease.Obstet Gynecol. 2013; 122: 778-786
- Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease.JAMA. 2013; 309: 689https://doi.org/10.1001/jama.2013.186
Jonsdottir GM, Jorgensen S, Cohen SL, Wright KN, Shah NT, Chavan N, et al. Increasing Minimally Invasive Hysterectomy. Obstetrics & Gynecology. 2011;117(5):1142-9.
- Robotic-Assisted Hysterectomy for Endometrial Cancer Compared With Traditional Laparoscopic and Laparotomy Approaches.Obstet Gynecol. 2010; 116: 1422-1431
- Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy, laparoscopy and laparotomy for endometrial cancer.European Journal of Obstetrics & Gynecology and Reproductive Biology. 2012; 165: 289-294
Article info
Publication history
Published online: August 11, 2021
Accepted:
July 21,
2021
Received in revised form:
July 15,
2021
Received:
May 26,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
