Robotic surgery for benign gynaecological disease
Abstract
Background
Robotic surgery is the latest innovation in the field of minimally invasive surgery. In the case of robotic surgery, instead of directly moving the instruments the surgeon uses a robotic system to control the instruments for surgical procedures. Robotic surgical systems have been used in various gynaecological surgeries for benign disease, such as hysterectomy (removal of the uterus), myomectomy (removal of uterine leiomyomas) and tubal reanastomosis (the reuniting of a divided tube). The mounting evidence demonstrates the feasibility and safety of robotic surgery in benign gynaecological disease. Robotic surgery is advertised as having promising advantages including more precise vision and procedures, improved ergonomics and shorter length of hospital stay. However, the main disadvantages of the robotic surgical system should not be overlooked, including the high cost of disposable instruments and retraining for both surgeons and nurses.
Objectives
To assess the effectiveness and safety of robot‐assisted surgery in the treatment of benign gynaecological disease.
Search methods
We searched the Cochrane Menstrual Disorders and Subfertility Group's Trial Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2011), MEDLINE and EMBASE up to November 2011 and citation lists of relevant publications.
Selection criteria
All randomised controlled trials (RCTs) comparing robotic surgery for benign gynaecological disease to laparoscopic or open surgical procedures. RCTs comparing different types of robotic assistants were also included. We contacted study authors for unpublished information, but failed in obtaining a response.
Data collection and analysis
Two review authors independently screened studies for inclusion. The domains assessed for risk of bias were allocation concealment, blinding, incomplete outcome data and selective outcome reporting. Odds ratios (OR) were used for reporting dichotomous data with 95% confidence intervals (CI), whilst
mean differences (MD) were determined for continuous data. Statistical heterogeneity was assessed using the I2 statistic. We contacted the primary authors for missing data but failed in obtaining a response.
Main results
Two trials involving 158 participants were included. Since one included trial was published in conference proceedings, limited usable data were available for further analysis. The only analysis in this trial showed comparable rates of conversions to open surgery between the robotic group and the laparoscopic group (OR 1.41, 95% CI 0.22 to 9.01; P = 0.72). One RCT showed longer operation time (MD 66.00, 95% CI 40.93 to 91.07; P < 0.00001), higher cost (MD 1936.00, 95% CI 445.69 to 3426.31; P = 0.01) in the robotic group compared with the laparoscopic group. Also, both studies reported that robotic and laparoscopic surgery seemed comparable regarding intraoperative outcome, complications, length of hospital stay and quality of life.
Authors' conclusions
Currently, the limited evidence showed that robotic surgery did not benefit women with benign gynaecological disease in effectiveness or in safety. Further well‐designed RCTs with complete reported data are required to confirm or refute this conclusion.
Plain language summary
Robotic surgery for benign gynaecological disease
In recent years, robotic surgery or robot‐assisted surgery has been developed to support a range of surgical procedures. Robotic surgery in benign gynaecological disease is one of the fastest growing areas, for conditions such as removal of the uterus or uterine fibroids, reuniting a divided tube, and to cure vaginal vault prolapse. Robotic surgery may lead to reduced blood loss, favourable complication rates, and short hospital stays. However, this systematic review found only limited evidence that refutes the previous points of view and does not support the use of robotic surgery for women with benign gynaecological disease.
