Robot-assisted hysterectomy: a critical evaluation

Abstract

Abstract: The introduction of robot-assisted surgery is one of the most remarkable and controversially discussed technological innovations of the past decade in the field of surgery. The technique has been used by an ever-growing number of surgeons in different surgical disciplines throughout the world. In the field of gynecologic surgery, besides myomectomy, hysterectomy in both benign and malignant conditions is one of the main indications for the use of robot-assisted surgery. The establishment of a robot-assisted approach to hysterectomy has led to an increase in minimally-invasive procedures compared to open surgery, accompanied by a decrease in the use of traditional laparoscopy. However, critics question the practical use of the technology and stress the often significantly longer operating room times as well as raised costs. There is a striking contrast between the emphasis put on possible weaknesses by critics on the one hand and the often uncritical marketing of the technology on the other hand. The purpose of this review is to provide a critical evaluation of the possible advantages and disadvantages of robot-assisted hysterectomy from the surgical, economic and organizational perspective based on the present literature. A Pubmed database search was performed using keywords such as robotic, robot-assisted, hysterectomy, training, benign and malignant. All publications were thoroughly reviewed regarding their ability to help evaluate the major benefits and challenges of robot-assisted hysterectomy compared to open or conventional laparoscopic procedures and to determine the current and possible future status of robotic surgery in the performance of hysterectomies. Keywords: robot-assisted surgery, laparoscopic surgery, gynecological surgery