title: Robot-assisted surgery in gynecological oncology: current status and controversies on patient benefits, cost and surgeon conditions - a systematic review.
abstract: BACKGROUND
  Robot-assisted surgery has become more widespread in gynecological oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment.
  
  
  METHODS
  A database search in PubMed and EMBASE was performed up until 4 March 2016. The search strategy was developed in collaboration with an information specialist, and by application of the PRISMA guidelines. Human participants and English language were the only restrictive filters applied. Selection was performed by screening of titles and abstracts, and by full text scrutiny. From 2001 to 2016, a total of 76 references were included.
  
  
  RESULTS
  Robot-assisted surgery in gynecological oncology has increased, and current knowledge supports that the oncological safety is similar, compared with previous surgical methods. Controversies arise because current knowledge does not clearly document the benefit of robot-assisted surgery, on perioperative outcome compared with the increased costs of the acquisition and application.
  
  
  CONCLUSIONS
  The rapid development in robot-assisted surgery calls for long-term detailed prospective cohorts or randomized controlled trials. The costs associated with acquisition, application, and maintenance have an unfavorable impact on cost-benefit evaluations, especially when compared with laparoscopy. Future developments in robot-assisted surgery will hopefully lead to competition in the market, which will decrease costs.
authors.affiliation: Faculty of Medicine, University of Copenhagen Health Science, Copenhagen, Denmark.
authors.forename: Steffen E
authors.initials: SE
authors.lastname: Kristensen
authors.affiliation: Gynecological Department, The Juliane Marie Center, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Berit J
authors.initials: BJ
authors.lastname: Mosgaard
authors.affiliation: Gynecological Department, The Juliane Marie Center, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Rosendahl
authors.affiliation: Gynecological Department, The Juliane Marie Center, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Tórur
authors.initials: T
authors.lastname: Dalsgaard
authors.affiliation: Gynecological Department, The Juliane Marie Center, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Signe F
authors.initials: SF
authors.lastname: Bjørn
authors.affiliation: Gynecological Department, The Juliane Marie Center, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Ligita P
authors.initials: LP
authors.lastname: Frøding
authors.affiliation: Section for Surgical Pathophysiology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.affiliation: Faculty of Medicine, University of Copenhagen Health Science, Copenhagen, Denmark.|Gynecological Department, The Juliane Marie Center, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Claus K
authors.initials: CK
authors.lastname: Høgdall
authors.affiliation: Gynecological Department, The Juliane Marie Center, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Lajer
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000191:economics / Q000295:instrumentation*; D006801:Humans; D007044:Hysterectomy / Q000193:education; D012371:Robotics / Q000191:economics; D014932:Women's Health Services / Q000191:economics
keywords: Cervical cancer; costs; endometrial cancer; ergonomics; gynecological oncology; ovarian cancer; robot-assisted surgery; robotic surgery; training