Robot‐assisted surgery in gynecological oncology: current status and controversies on patient benefits, cost and surgeon conditions – a systematic review

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 96; no. 3; pp. 274 - 285
• Main Authors: Kristensen, Steffen E., Mosgaard, Berit J., Rosendahl, Mikkel, Dalsgaard, Tórur, Bjørn, Signe F., Frøding, Ligita P., Kehlet, Henrik, Høgdall, Claus K., Lajer, Henrik
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2017
• Subjects: Cervical cancer; Cost-Benefit Analysis; Costs; endometrial cancer; ergonomics; Female; Genital Neoplasms, Female - surgery; Gynecologic Surgical Procedures - economics; Gynecologic Surgical Procedures - instrumentation; gynecological oncology; Gynecology; Humans; Hysterectomy - education; Oncology; ovarian cancer; robotic surgery; Robotics - economics; Robots; robot‐assisted surgery; Surgery; training; Women's Health Services - economics; costs; robot-assisted surgery; ovarian cancer; ergonomics; endometrial cancer; training; gynecological oncology; Cervical cancer; robotic surgery
• ISSN: 0001-6349; 1600-0412
• DOI: 10.1111/aogs.13084

Introduction 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. Material and 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 s, 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.