Abstract
The da Vinci® Surgical System dominates robotic surgery, as the only robotic device to have FDA approval in gynaecology. The benefits of robot-assisted surgery include decreased length of stay, decreased blood loss and analgesic requirements. Ergonomic improvements allow the surgeon to operate with less risk of neck and back injury. Unfortunately the initial economic impact of purchasing and maintaining a robot are great but must be balanced with the potential savings from reduced length of stay and earlier return to normal activity. This review looks at the uses for the robot in both gynaecology and urogynaecology, assessing the efficacy of this modality compared to both straight stick (laparoscopy) and open procedures. We assess the benefits to both patient and surgeon from the available literature. Within the current economic environment we appraise the costs associated with the robot.
Similar content being viewed by others
References
Reza M et al (2010) Meta-analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery. Br J Surg 97(12):1772–83
Advincula AP, Falcone T (2004) Laparoscopic robotic gynecologic surgery. Obstet Gynecol Clin North Am 31(3):599–609, ix–x
Ho C, Tsakonas E, Tran K, Cimon K et al (2011) Robot-Assisted Surgery Compared with Open Surgery and Laparoscopic Surgery: Clinical Effectiveness and Economic Analyses. Canadian Agency for Drugs and Technologies in Health
Camberlin C, Senn A, Leys M, De Laet C (2009) Robot-assisted surgery: health technology assessment. B.H.C.K.C. (KCE), Editor
Secretariat MA (2010) Robotic-assisted minimally invasive Surgery for gynecologic and urologic oncology. O.H.T.A.S. 2010, Editor
Thavaneswaran, P.e.a., Robotic-assisted surgery for urological, cardiac and gynaecological procedures., ASERNIP-S, Editor 2009: Adelaide
HIQA, Health technology assessment of robot-assisted surgery in selected surgical procedures, H.I.a.Q. Authority, Editor 2012: Dublin
Maher CM et al (2011) Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J 22(11):1445–57
Ganatra AM et al (2009) The current status of laparoscopic sacrocolpopexy: a review. Eur Urol 55(5):1089–103
Akladios CY et al (2010) Laparoscopic sacrocolpopexy for female genital organ prolapse: establishment of a learning curve. Eur J Obstet Gynecol Reprod Biol 149(2):218–21
Claerhout F et al (2009) Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol 55(6):1459–67
Subramanian D et al (2009) Rate, type, and cost of pelvic organ prolapse surgery in Germany, France, and England. Eur J Obstet Gynecol Reprod Biol 144(2):177–81
Paraiso MF et al (2011) Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol
White WM et al (2009) Single-port laparoscopic abdominal sacral colpopexy: initial experience and comparative outcomes. Urology 74(5):1008–12
Lenihan JP Jr, Kovanda C, Seshadri-Kreaden U (2008) What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol 15(5):589–94
Daneshgari F et al (2007) Robotic abdominal sacrocolpopexy/sacrouteropexy repair of advanced female pelvic organ prolaspe (POP): utilizing POP-quantification-based staging and outcomes. BJU Int 100(4):875–9
Geller EJ et al (2008) Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 112(6):1201–6
Elliott DS, Krambeck AE, Chow GK (2006) Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol 176(2):655–9
Gocmen A, Sanlikan F, Ucar MG (2011) Robotic-assisted sacrocolpopexy/sacrocervicopexy repair of pelvic organ prolapse: initial experience. Arch Gynecol Obstet
Gilleran JP, Johnson M, Hundley A (2010) Robotic-assisted laparoscopic mesh sacrocolpopexy. Ther Adv Urol 2(5–06):195–208
Wattiez A (2003) Laparoscopic repair of vaginal vault prolapse. Curr Opin Obstet Gynecol 15:315–19
Chan SS et al (2011) Laparoscopic sacrocolpopexy for the treatment of vaginal vault prolapse: with or without robotic assistance. Hong Kong Med J 17(1):54–60
Di Marco DS et al (2004) Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. Urology 63(2):373–6
Freilich DA et al (2010) Parental satisfaction after open versus robot assisted laparoscopic pyeloplasty: results from modified Glasgow Children’s Benefit Inventory Survey. The Journal of urology 183(2):704–8
Ridgeway B, Frick AC, Walter MD (2008) Hysteropexy. A review. Minerva ginecologica 60(6):509–28
Maher CF, Carey MP, Murray CJ (2001) Laparoscopic suture hysteropexy for uterine prolapse. Obstetrics and gynecology 97(6):1010–4
Krause HG et al (2006) Laparoscopic sacral suture hysteropexy for uterine prolapse. Int Urogynecolog J Pelvic Floor Dysfunct 17(4):378–81
Feiner B, Gietelink L, Maher C (2010) Anterior vaginal mesh sacrospinous hysteropexy and posterior fascial plication for anterior compartment dominated uterovaginal prolapse. Int Urogynecol J 21(2):203–8
Price N, Slack A, Jackson SR (2010) Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse. BJOG 117(1):62–8
Cvach K, Dwyer P (2011) Surgical management of pelvic organ prolapse: abdominal and vaginal approaches. World J Urol
Busby G, Broome J (2010) Successful pregnancy outcome following laparoscopic sacrohysteropexy for second degree uterine prolapse. Gynecol Surg 7:271–273
Lewis CM, Culligan P (2011) Sacrohysteropexy followed by successful pregnancy and eventual reoperation for prolapse. Int Urogynecol J
Vitobello D, Siesto G, Bulletti C (2012) Robotic sacral hysteropexy for pelvic organ prolapse. Int J Med Robot
Melamud O et al (2005) Laparoscopic vesicovaginal fistula repair with robotic reconstruction. Urology 65(1):163–6
Sundaram BM, Kalidasan G, Hemal AK (2006) Robotic repair of vesicovaginal fistula: case series of five patients. Urology 67(5):970–3
Reynolds R, Advincula AP (2006) Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg 191:555–560
Bell MC et al (2008) Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol 111(3):407–11
Boggess JF et al (2008) A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol 199(4):357, e1-7
Boggess JF et al (2008) A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol 199(4):360, e1-9
DeNardis SA et al (2008) Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol 111(3):412–7
Estape R et al (2009) A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy. Gynecol Oncol 113(3):357–61
Geisler JP et al (2010) Robotically assisted laparoscopic radical hysterectomy compared with open radical hysterectomy. Int J Gynecol Cancer 20(3):438–42
Gocmen A, Sanlikan F, Ucar MG (2010) Comparison of robotic-assisted surgery outcomes with laparotomy for endometrial cancer staging in Turkey. Arch Gynecol Obstet 282(5):539–45
Cantrell LA et al (2010) Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: a 3-year experience. Gynecol Oncol 117(2):260–5
Veljovich DS et al (2008) Robotic surgery in gynecologic oncology: program initiation and outcomes after the first year with comparison with laparotomy for endometrial cancer staging. Am J Obstet Gynecol 198(6):679 e1-9; discussion 679 e9-10
Schreuder HW et al (2010) From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve. Gynecol Surg 7(3):253–258
Seamon LG et al (2009) Comprehensive surgical staging for endometrial cancer in obese patients: comparing robotics and laparotomy. Obstet Gynecol 114(1):16–21
Nam EJ et al (2010) A case-control study of robotic radical hysterectomy and pelvic lymphadenectomy using 3 robotic arms compared with abdominal radical hysterectomy in cervical cancer. Int J Gynecol Cancer 20(7):1284–9
Nevadunsky N, Clark R, Ghosh S, Muto M, Berkowitz R, Vitonis A et al (2010) Comparison of robot-assisted total laparoscopic hysterectomy and total abdominal hysterectomy for treatment of endometrial cancer in obese and morbidly obese patients. J Robot Surg 4(4):247–52
Matthews CA et al (2010) Evaluation of the introduction of robotic technology on route of hysterectomy and complications in the first year of use. Am J Obstet Gynecol 203(5):499, e1–5
Lowe MP (2009) A comparson of robot-assisted and traditional radical hysterectomy for early-stage cervical cancer. J Robot Surg 3(1):19–23
Maggioni A et al (2009) Robotic approach for cervical cancer: comparison with laparotomy: a case control study. Gynecol Oncol 115(1):60–4
Goel M, Zollinger T, Moore D (2011) Surgical staging of endometrial cancer: robotic versus open technique outcomes in a contemporary single surgeon series. J Robot Surg 5(2):109–114
Halliday D, Lau S, Vaknin Z, Deland C, Levental M, McNamara E (2010) et al, Robotic radical hysterectomy: comparison of outcomes and cost. Journal of Robotic Surgery 4(4):211–216
Gocmen A, Sanlikan F, Ucar M (2010) Comparison of outcomes between laparotomy and robotic technique for cervical cancer. J Robot Surg 4(2):123–127
Jung YW et al (2010) Robot-assisted staging using three robotic arms for endometrial cancer: comparison to laparoscopy and laparotomy at a single institution. J Surg Oncol 101(2):116–21
Ko EM et al (2008) Robotic versus open radical hysterectomy: a comparative study at a single institution. Gynecol Oncol 111(3):425–30
Cardenas-Goicoechea J et al (2010) Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center. Gynecol Oncol 117(2):224–8
Gehrig PA et al (2008) What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol 111(1):41–5
Giep BN, Giep HN, Hubert HB (2010) Comparison of minimally invasive surgical approaches for hysterectomy at a community hospital: robotic-assisted laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy and laparoscopic supracervical hysterectomy. J Robot Surg 4(3):167–175
Holtz DO et al (2010) Endometrial cancer surgery costs: robot vs laparoscopy. J Minim Invasive Gynecol 17(4):500–3
Lim PC, Kang E, Park do H (2011) A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients. Gynecol Oncol 120(3):413–8
Nezhat C et al (2009) Laparoscopic hysterectomy with and without a robot: stanford experience. JSLS 13(2):125–8
Payne TN, Dauterive FR (2008) A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 15(3):286–91
Sarlos D et al (2010) Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study. Eur J Obstet Gynecol Reprod Biol 150(1):92–6
Seamon LG et al (2009) Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol 113(1):36–41
Sert B, Abeler V (2007) Robotic radical hysterectomy in early-stage cervical carcinoma patients, comparing results with total laparoscopic radical hysterectomy cases. The future is now? Int J Med Robot 3(3):224–8
Shashoua AR, Gill D, Locher SR (2009) Robotic-assisted total laparoscopic hysterectomy versus conventional total laparoscopic hysterectomy. JSLS 13(3):364–9
Dharia Patel SP et al (2008) Robotic tubal anastomosis: surgical technique and cost effectiveness. Fertil Steril 90(4):1175–9
Cronin C, Hewitt M, Harley I, O’Donoghue K, O’Reilly BA (2012) Robot-assisted laparoscopic cervical cerclage as an interval procedure. Gynecological Surgery. in press
Barakat EE et al (2011) Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol 117(2 Pt 1):256–65
Ascher-Walsh CJ, Capes TL (2010) Robot-assisted laparoscopic myomectomy is an improvement over laparotomy in women with a limited number of myomas. J Minim Invasive Gynecol 17(3):306–10
Nezhat C et al (2010) Robotic versus standard laparoscopy for the treatment of endometriosis. Fertil Steril 94(7):2758–60
Magrina JF et al (2009) Robotic adnexectomy compared with laparoscopy for adnexal mass. Obstet Gynecol 114(3):581–4
Lambaudie E et al (2010) Role of robot-assisted laparoscopy in adjuvant surgery for locally advanced cervical cancer. Eur J Surg Oncol 36(4):409–13
Yim GW et al (2011) Role of robot-assisted surgery in cervical cancer. Int J Gynecol Cancer 21(1):173–81
Pasic R, Rizzo J, Fang H (2010) Comparing robot-assisted with conventional laparoscopic hysterectomy: impact on cost and clinical outcome. J Minim Invasive Gynecol 17(1):730–738
Judd JP et al (2010) Cost-minimization analysis of robotic-assisted, laparoscopic, and abdominal sacrocolpopexy. J Minim Invasive Gynecol 17(4):493–9
Subak LL et al (2001) Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 98(4):646–51
Banta D (2003) The development of health technology assessment. Health policy 63(2):121–32
Banta HD, Gelband H, Jonsson E, Battista R (1994) Health care technology and its assessment in eight countries. Health Policy 30:1–2
Bokhari MB et al (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25(3):855–60
Seamon LG et al (2009) A detailed analysis of the learning curve: robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Gynecologic oncology 114(2):162–7
Akl MN et al (2009) Robotic-assisted sacrocolpopexy: technique and learning curve. Surg Endosc 23(10):2390–4
Kramer BA et al (2009) Robot-assisted laparoscopic sacrocolpopexy as management for pelvic organ prolapse. J Endourol 23(4):655–8
Elliott DS (2007) Assessment of the durability of robot-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. J Robotic Surg 1:163–8
Muffly T et al (2009) An evaluation of knot integrity when tied robotically and conventionally. Am J Obstet Gynecol 200(5):e18–20
Yohannes P et al (2002) Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology 60(1):39–45, discussion 45
Ng JS et al (2011) Gynaecologic robot-assisted cancer and endoscopic surgery (GRACES) in a tertiary referral centre. Ann Acad Med Singapore 40(5):208–5
Coelho RF et al (2009) Robotic-assisted radical prostatectomy: a review of current outcomes. BJU Int 104(10):1428–35
Coelho RF et al (2010) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol 24(12):2003–15
Rassweiler J, Hruza M, Klein J, Goezen AS, Leber D (2010) The role of laparoscopic radical prostatectomy in the era of robotic surgery. European Urology, Supplements 9(3):379–87
Okamura AM (2009) Haptic feedback in robot-assisted minimally invasive surgery. Curr Opin Urol 19(1):102–7
Lawson EH, Curet MJ, Sanchez BR, Schuster R, Berguer R (2007) Postural ergonomics during robotic and laparoscopic gastric bypass surgery: a pilot project. J Robot Surg 1(1):61–8
Council NHaMR (2009) NHMRC additional levels of evidence and grades for recommendations for developers of guidelines
Collins S, Tulikangas P (2010) Randomized trials in robotic surgery: a practical impossibility? Int Urogynecol J 21(9):1045–7
Murphy D (2008) Robotic technology in surgery: current status in 2008. ANZ J Surg 78(5):1076–1081
Financial Disclaimers/Conflict of Interest
OE O’Sullivan: Dr O’Sullivan has no financial disclaimers or conflict of interest to disclose.
BA O’Reilly: Dr O’Reilly is a proctor for Intuitive, all financial reimbursement from the company are placed in the departments research fund
The Cork University Maternity Hospital is an Intuitive recognized epicentre for Robotic surgical training. All funds received form this are placed in the departments research fund.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
O’Sullivan, O.E., O’Reilly, B.A. Robot-assisted surgery:—impact on gynaecological and pelvic floor reconstructive surgery. Int Urogynecol J 23, 1163–1173 (2012). https://doi.org/10.1007/s00192-012-1790-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-012-1790-3