New technologies for reproductive medicine: laparoscopy, endoscopy, robotic surgery and gynecology. A review of the literature.

Abstract

Computer-enhanced telesurgery, called robotic-assisted surgery, is the latest innovation in the minimal invasive surgery field. In gynecology, this machine has been applied in several applications, in the fields of benign gynecology, reproductive medicine, urogynecology, and oncology. The purpose of this paper was to review the published scientific literature regarding robotics and its application to gynecology thus far and summarize findings of this computer enhanced laparoscopic technique. Relevant sources were identified by a Pubmed/Medline search looking at databases from January 1950 to July 2009. A total of 29 papers in benign gynecology were identified, and a total of 44 articles were analyzed involving gynecologic oncology. The estimated blood loss, number of lymph nodes extracted, operating time, length of hospital stay and complications were noted among all the studies. The data shows comparable results between robotic and laparoscopic surgery in terms of estimated blood loss, operative time, length of hospital stay, and complications for gynecologic cancer. Overall, there were more wound complications in the laparotomy approach compared to laparoscopy and robotic assisted laparoscopy. There were more lymphocysts, lymphoceles, and lymphedema in the robotic assisted laparoscopic group compared to the laparoscopy and laparotomy groups in cervical cancer patients. Infectious and lung-related morbidity, postoperative ileus, and bleeding/clot formation was more commonly reported in the laparotomy group compared the other two cohorts in endometrial cancer patients. Computer enhanced technology may enable more surgeons to convert their laparotomies to laparoscopic surgery with its associated benefits. It appears that in the hands of experienced laparoscopic surgeons, final outcomes are the same when using or not using the robot. There is good evidence that robotic surgery facilitates laparoscopic surgery, with equivalent if not better operative time and comparable surgical outcomes, shorter hospital stays, and fewer major complications than those surgeries utilizing the laparotomy approach.