title: 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.
  
  
  OBJECTIVE
  To assess the effectiveness and safety of robot-assisted surgery in the treatment of benign gynaecological disease.
  
  
  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.
  
  
  METHODS
  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 We contacted study authors for unpublished information, but failed in obtaining a response.
  
  
  METHODS
  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 I(2) statistic. We contacted the primary authors for missing data but failed in obtaining a response.
  
  
  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.
  
  
  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.
authors.affiliation: Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
authors.forename: Hongqian
authors.initials: H
authors.lastname: Liu
authors.forename: DongHao
authors.initials: D
authors.lastname: Lu
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Gang
authors.initials: G
authors.lastname: Shi
authors.forename: Huan
authors.initials: H
authors.lastname: Song
authors.forename: Jane
authors.initials: J
authors.lastname: Clarke
mesh_terms: D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012371:Robotics / Q000191:economics / Q000379:methods*; D013997:Time Factors