title: Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: A systematic review and meta-analysis.
abstract: OBJECTIVE
  This study aimed to evaluate the surgical safety and clinical effectiveness of RH compared to OH and LH for endometrial cancer.
  
  
  METHODS
  We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane library for studies published through May 2015. The outcomes of interest included safety (overall; peri-operative and post-operative complications; death within 30-days; and specific morbidities), effectiveness (survival, recurrence, length of stay [LOS], estimated blood loss [EBL], and operative time [OT]), and patient-reported outcomes (pain score, pain medication use, length of pain medication use, and time to return to work). Two independent reviewers extracted data and assessed the risk of bias.
  
  
  RESULTS
  Twenty-four studies comparing RH to OH and 24 comparing RH to LH were identified. No significant differences were found in survival outcomes. The LOS was shorter, there was less EBL, and the rates of complications, readmission, and transfusion were lower with RH compared to OH. However, RH showed a longer OT and a higher incidence of vaginal cuff dehiscence compared to those for OH. Compared to LH, the LOS was shorter, there was less EBL, and the rates of conversion to laparotomy, intra-operative complications, urinary tract injuries, and cystotomy were lower in RH. Several patient-reported outcomes showed a significant benefit of RH, but each outcome was reported in only one study.
  
  
  CONCLUSIONS
  RH may be a generally safer and better option than OH and LH for patients with endometrial cancer. Further prospective studies with long-term follow-up are required.
authors.affiliation: Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea.
authors.forename: D A
authors.initials: DA
authors.lastname: Park
authors.affiliation: Clinical Research Center, Woosuk University Korean Medicine Hospital, Jeonju, South Korea.
authors.forename: D H
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Gynaecology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: S W
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Nursing Science, College of Nursing, Gachon University, Incheon, South Korea. Electronic address: sunarea87@gachon.ac.kr.
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000601:surgery*; D000700:Analgesics / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D018269:Carcinoma, Endometrioid / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D000071066:Patient Reported Outcome Measures; D011183:Postoperative Complications / Q000453:epidemiology*; D065287:Robotic Surgical Procedures / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Endometrial cancer; Laparoscopic hysterectomy; Open hysterectomy; Radical hysterectomy; Robotic hysterectomy