title: Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review.
abstract: Total and radical hysterectomies are the most common treatment strategies for early-stage endometrial and cervical cancers, respectively. Surgical modalities include open surgery, laparoscopy, and more recently, minimally invasive robot-assisted surgery. We searched several electronic databases for randomized controlled trials and observational studies with a comparison group, published between 2009 and 2014. Our outcomes of interest included both perioperative and morbidity outcomes. We included 35 observational studies in this review. We did not find any randomized controlled trials. The quality of evidence for all reported outcomes was very low. For women with endometrial cancer, we found that there was a reduction in estimated blood loss between the robot-assisted surgery compared to both laparoscopy and open surgery. There was a reduction in length of hospital stay between robot-assisted surgery and open surgery but not laparoscopy. There was no difference in total lymph node removal between the three modalities. There was no difference in the rate of overall complications between the robot-assisted technique and laparoscopy. For women with cervical cancer, there were no differences in estimated blood loss or removal of lymph nodes between robot-assisted and laparoscopic procedure. Compared to laparotomy, robot-assisted hysterectomy for cervical cancer showed an overall reduction in estimated blood loss. Although robot-assisted hysterectomy is clinically effective for the treatment of both endometrial and cervical cancers, methodologically rigorous studies are lacking to draw definitive conclusions.
authors.affiliation: Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada. immaculatenevis@yahoo.ca.
authors.forename: Immaculate F
authors.initials: IF
authors.lastname: Nevis
authors.affiliation: Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada.
authors.forename: Bahareh
authors.initials: B
authors.lastname: Vali
authors.affiliation: Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Higgins
authors.affiliation: Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada.|Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
authors.forename: Irfan
authors.initials: I
authors.lastname: Dhalla
authors.affiliation: Toronto General Hospital, University of Toronto, Toronto, ON, M5G 2M9, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Urbach
authors.affiliation: Department of Gynecologic Oncology, Princess Margaret Hospital, University of Toronto, 610, University Avenue, Toronto, ON, M5G 2M9, Canada.
authors.forename: Marcus Q
authors.initials: MQ
authors.lastname: Bernardini
mesh_terms: D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000601:surgery*
keywords: Cervical cancer; Effectiveness; Endometrial cancer; Hysterectomy; Laparoscopy; Laparotomy; Robot assisted; Systematic review