title: Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy.
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.
authors.affiliation: Department of Obstetrics and Gynecology, Ochsner Clinical School, New Orleans, Louisiana. Electronic address: rgala@ochsner.org.
authors.forename: Rajiv B
authors.initials: RB
authors.lastname: Gala
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Medical Center, Oakland, California.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Margulies
authors.affiliation: Department of Obstetrics and Gynecology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, Connecticut.
authors.forename: Adam
authors.initials: A
authors.lastname: Steinberg
authors.affiliation: Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales, Pennsylvania.
authors.forename: Miles
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.
authors.forename: James
authors.initials: J
authors.lastname: Lukban
authors.affiliation: Women and Infants Hospital of Rhode Island, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Peter
authors.initials: P
authors.lastname: Jeppson
authors.affiliation: Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin.
authors.forename: Sarit
authors.initials: S
authors.lastname: Aschkenazi
authors.affiliation: Department of Obstetrics and Gynecology, State University of New York Downstate Medical Center, Brooklyn, New York.
authors.forename: Cedric
authors.initials: C
authors.lastname: Olivera
authors.affiliation: Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Mary
authors.initials: M
authors.lastname: South
authors.affiliation: Urogynecology Service, Rambam Health Care Campus, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, and Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Lior
authors.initials: L
authors.lastname: Lowenstein
authors.affiliation: Urogynecology Service, Rambam Health Care Campus, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, and Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schaffer
authors.affiliation: Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Balk
authors.affiliation: Women and Infants Hospital of Rhode Island, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Vivian
authors.initials: V
authors.lastname: Sung
mesh_terms: D000328:Adult; D016889:Endometrial Neoplasms / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D006176:Gynecology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D059032:Learning Curve; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012371:Robotics / Q000191:economics / Q000706:statistics & numerical data*; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Gynecologic surgery; Learning curve; Robotic surgery; Systematic review