Applications of different energy devices in laparoscopic and robotic gynecological surgery: a systematic review

Abstract

PURPOSE: This study aims to evaluate and summarize the existing literature regarding the safety, efficacy, and outcomes of various energy sources in minimally invasive gynecological surgeries. METHODS: A systematic review was conducted by searching the PubMed/MEDLINE, Cochrane Library, and Web of Science databases. We included studies that compared different energy sources used in laparoscopic and robotic gynecological surgeries, focusing on their advantages and complications. 37 studies were ultimately included in this review. RESULTS: Among the 37 studies, 24 were randomized controlled trials, 11 were retrospective studies, and 1 was prospective. In laparoscopic procedures, advanced energy sources were associated with reduced intraoperative blood loss and shorter operative times. Specifically, ultrasonic devices demonstrated significantly less thermal damage and facilitated easier postoperative histologic assessment of lymph nodes compared to conventional electrosurgery. In robotic assisted surgeries, the literature reported shorter hospital stays and reduced thermal injury during colpotomy when utilizing laser energy. No significant differences were observed in other perioperative outcomes across both minimally invasive approaches. CONCLUSION: Advanced energy devices may offer advantages in gynecological minimally invasive surgery, particularly in minimizing tissue trauma and enhancing surgical precision. However, evidence on outcomes such as lateral thermal spread and tissue healing remains limited and inconsistent. Further high-quality comparative studies are needed to clarify the clinical implications of each energy source and guide optimal instrument selection, especially in robotic assisted procedures.