title: Surgical and clinical safety and effectiveness of robot-assisted laparoscopic hysterectomy compared to conventional laparoscopy and laparotomy for cervical cancer: A systematic review and meta-analysis.
abstract: OBJECTIVE
  This study aimed to evaluate the surgical safety and clinical effectiveness of RH versus LH and laparotomy for cervical cancer.
  
  
  METHODS
  We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane library through May 2015, and checked references of relevant studies. We selected the comparative studies reported the surgical safety (overall; peri-operative; and post-operative complications; death within 30 days; and specific morbidities), and clinical effectiveness (survival; recurrence; length of stay [LOS]; estimated blood loss [EBL]; operative time [OT]) and patient-reported outcomes.
  
  
  RESULTS
  Fifteen studies comparing RH with OH and 11 comparing RH with LH were identified. No significant differences were found in survival outcomes. The LOS was shorter and transfusion rate was lower with RH compared to OH or LH. EBL was significantly reduced with RH compared to OH. Compared to OH, overall complications, urinary infection, wound infection, and fever were significantly less frequent with RH. The overall, peri-operative, and post-operative complications were similar in other comparisons. Several patient-reported outcomes were improved with RH, though each outcome was reported in only one study.
  
  
  CONCLUSIONS
  RH appears to have a positive effect in reducing overall complications, individual adverse events including wound infection, fever, urinary tract infection, transfusion, LOS, EBL, and time to diet than OH for cervical cancer patients. Compared to LH, the current evidence is not enough to clearly determine its clinical safety and effectiveness. Further rigorous prospective studies with long-term follow-up that overcome the many limitations of the current evidence are needed.
authors.affiliation: Health Technology Assessment Research Team, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
authors.forename: D A
authors.initials: DA
authors.lastname: Park
authors.affiliation: Health Technology Assessment Research Team, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
authors.forename: J E
authors.initials: JE
authors.lastname: Yun
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: san1@yuhs.ac.
authors.forename: S W
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Nursing Science, College of Nursing, Gachon University, Incheon, Republic of Korea. Electronic address: sunarea87@gachon.ac.kr.
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D065287:Robotic Surgical Procedures / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery*
keywords: Cervical cancer; Laparoscopic hysterectomy; Open hysterectomy; Radical hysterectomy; Robotic hysterectomy