We have recently published a prospective study showing that robotic assistance is associated with shorter operative times and less bleeding in the case of laparoscopic hysterectomies performed by surgeons in their learning curve. Hysterectomies are obviously not “reproductive surgery”, but reproductive surgeons starting to perform other complex procedures (e.g. laparoscopic myomectomy) could possibly benefit from robotic assistance. Nevertheless, proficiency can be reached also in conventional laparoscopy (usually a long process though…) and the costs of robotics are still high. However, in the (near) future things will probably change.
Maria Angeles Martínez-Maestre *, Pietro Gambadauro *, Carmen González-Cejudo, Rafael Torrejón (* contributed equally)
Surg Innov. 2013 DOI: 10.1177/1553350613492023
Background. Hysterectomies are very common, and most of them are still performed abdominally. The minimally invasive alternatives are perceived as difficult by gynecologists. Robotic assistance is thought to facilitate laparoscopic surgery. The aim of this study was to compare the surgical outcomes of robotic-assisted and conventional total laparoscopic hysterectomy. Methods. Patients, candidate to hysterectomy for benign indications, were allocated to either robotic or conventional laparoscopy in a quasi-randomized fashion. Patients were operated following a standardized surgical protocol. Main outcome measures were total surgical time, conversions to laparotomy, blood loss, hospital stay, and complications. Results. Fifty-one patients underwent robotic hysterectomy (mean age = 46.59 years) and 54 conventional laparoscopy (mean age = 50.02 years). The groups were homogeneous in body mass index and uterine weight. Robotic-assisted hysterectomies were significantly shorter (154.63 ± 36.57 vs 185.65 ± 42.98 minutes in the control group; P = .0001). Patients in the robotic group also had a significantly smaller reduction in hemoglobin (9.69% ± 8.88% vs 15.29% ± 8.39% in controls; P = .0012) and hematocrit (10.56% ± 8.3% vs 14.89% ± 8.11%; P = .008). No intraoperative conversions to laparotomy were required. Complication rate was low and similar in both groups. All patients were fully recovered at 1-month follow-up outpatient visit. Conclusions. Significantly lower operative times and blood loss indicate that robotic assistance can facilitate surgery already during the learning curve period. Nevertheless, proficiency can be reached in conventional laparoscopy through training, and the cost-effectiveness of robotic hysterectomy for benign conditions is yet to be confirmed.