Robotic-Assisted Gynecology: Expanding the Potential of Advanced Robotics View PDF

During the last 30 years, gynecologic surgeons have expanded their surgical range to include marginally interfering surgery. The advantages of robot-assisted surgery include the ability to use joint-wristed tools, control tremors, and view and manipulate tissues in three-dimensional (3D) stereoscopic views. It was approved in 2005 by the US food and drug administration (FDA) for a limited range of gynecologic operations using the da Vinci Surgical System. Currently, the system is the only FDA-approved robotic stage on the market. There are a number of advantages to this platform over traditional laparoscopy, including less postoperative discomfort, improved surgeon ergonomics, quicker analysis of instrumentation curves, elimination of fulcrum effects, and a more ordered integration of fluorescence technology for lymphovascular estimation. Since the early 1980s, LAP has evolved steadily [1]. It has taken four decades for LAP to become a standard approach, despite its initial slow adoption. There is no doubt that LAP has a number of advantages over open surgery. In contrast to traditional open surgery, LAP minimizes damage to surrounding tissues by using small incisions and specialized surgical instruments. This results in reduced pain, reduced blood loss, fewer postoperative complications, shorter hospital stays, a faster recovery, and a lower morbidity rate [2]. 

Within the last decade, RAS has MIS in urology and has continued to do so. It was challenging for urologists to switch from open surgery to LAP because LAP comes with a steep learning curve [3]. RAS accelerated this transition by nearly tenfold, shortening the learning curve by nearly tenfold. During training in general surgery procedures such as hepaticojejunostomy and gastrojejunostomy, residents scored more nervousness and anxiety for laparoscopy than for RAS, according to a recent study. Laparoscopic drills performed better than robotic drills in terms of technical performance [4]. In contrast, RAS is being adopted more slowly in gynecological surgery. With a tendency to expand to new indications, RAS has now been used for hysterectomy, oophorectomy, salpingectomy, myomectomy, ovarian cystectomy, lymphadenectomy, endometriosis surgery, sacrocolpopexy, and pelvic exenteration, among many other benign and malignant conditions [5]. A relatively rapid transition has been occurring in hysterectomies, the most frequently performed major gynecological surgical procedure. Hysterectomies performed with RAS were proven to be noninferior to those performed with conventional LAP. As a result of shorter hospital stays, intraoperative complications and, therefore, conversion rates were either unchanged or reduced in RAS, though one study found that robot assisted surgery caused more postoperative pain than LAP (Figure 1).

Study after study has reported significant reductions in open surgery rates due to the benefits of MIS in gynecological surgery [6]. The surgical community is interested in developing awareness and accelerating the adoption of more advanced technologies in robotics in gynecological surgery, according to a number of recent published reviews. The use of MIS to completely replace traditional open surgery continues to be hindered by a few factors, despite recommendations from international guidelines. Conventional laparoscopy is capable of performing nearly all surgeries performed by gynecologists, and advanced technology does not appear to be required in the future. The community still has a difficult time accepting RAS [7]. Does this have anything to do with technological limitations, accessibility, or both? Furthermore, we discussed the advantages and limitations of RAS compared to LAP.