Robotic-assisted surgery in gynecology showed favorable perioperative outcomes in small retrospective studies, but current evidence remains insufficient to determine whether newer robotic platforms improve outcomes compared with conventional laparoscopy, according to an editorial published in Women’s Health.
The editorial summarized three articles in a special collection on robotics in gynecology and reproductive medicine: one editorial on fertility following pouch surgery and two retrospective studies of newer robotic systems.
In one single-center study of the Hugo robotic-assisted surgery system, researchers evaluated 20 patients undergoing gynecologic procedures, including hysterectomy in 18 patients, uterine mass excision in one patient, and myomectomy in one patient. The researchers reported efficient docking time, short surgical duration, minimal blood loss, short hospital stay, few postoperative complications, and low pain perception.
The editorial noted that newer robotic-assisted surgery systems have reduced costs in recent years compared with Da Vinci systems, although cost-effectiveness remains an important area for future research.
In a second retrospective study, researchers evaluated 24 patients who underwent hysterectomy with the Dexter robotic system for indications including endometrial cancer, endometriosis, and uterine fibroids. The editorial described Dexter as an open robotic platform designed to allow integration and easy switching between laparoscopic and robotic interfaces. In the study, additional procedures such as radical lymphadenectomy and deep-infiltrating endometriosis surgery were performed mostly with conventional laparoscopy.
No intraoperative complications or conversions to laparotomy occurred in the Dexter study. Four of 24 patients experienced Clavien-Dindo grade III postoperative complications, including three vaginal dome infections and one umbilical trocar-site hernia. The vaginal dome infection rate was 12.5%, exceeding rates cited in prior literature for conventional laparoscopic hysterectomy and robotic hysterectomy for malignant indications.
The editorial also discussed the potential role of robotic-assisted surgery in fertility preservation among patients undergoing total proctocolectomy with ileal pouch–anal anastomosis for ulcerative colitis. Improved pelvic visualization and tissue dissection may plausibly reduce fibrosis, adhesions, and tubal occlusion, but the editorial noted that no study has evaluated whether robotic-assisted surgery reduces infertility rates following the procedure.
Both retrospective studies were limited by small cohorts and single-center designs. The Hugo study also lacked a comparison group, limiting interpretation of outcomes relative to conventional laparoscopy or other robotic systems. The editorial emphasized the need for observational and randomized studies comparing newer robotic platforms with laparoscopic surgery, as well as studies evaluating long-term outcomes, cost-effectiveness, and standardized training curricula.
“Further research is needed to develop and establish newer robotic surgical techniques and technologies,” wrote Panagiotis Peitsidis, of Helena Venizelou Hospital in Athens, Greece, and Christos Iavazzo, of Metaxa Cancer Hospital in Piraeus, Greece.
The researchers reported no conflicts of interest and no external funding.
Source: Women's Health
Editor's note: The editorial summarized primary data from studies published within the same Women’s Health special collection.
