Review Article

Robotic Surgery in Gynecology: An Updated Systematic Review

Table 1

Comparative observational studies evaluating the da vinci robotic system (DRS) versus open surgery (OS) or laparoscopy (LSC) to perform general gynecologic as well as reproductive and urogynecologic procedures.

SurgeryNDRS versus OSDRS versus LSCControlSurg-eonOR time (min.)EBL (mL)Hospital stay (days)Conversions to OSBld TxIntraoperative complicationsPostoperative complicationsClinical outcomes

Adnexectomy
Margina et al. [24] 200885 versus 91CCSS77 versus 62   (median)25 versus 50 (median)0 versus 0 (median)001/85 versus 2/90 uretral injury (1) versus uretral injury (1) and rectotomy (1)Major: none
Minor:10/81 versus 10/91

Myomectomy
Advincula et al. [25]
2000–2004
29 versus 29CC
matched
DS231 versus 154196 versus 3651.5 versus 3.600 versus 21/29 versus 0/29cardiogenic shot from vasopressin (1)Major: 0 versus 3arrest, DVT, ARF in same pt. (1), bld tx (2)
Minor: 3/29 versus 11/29

Nezhat et al. [18]
2006-2007
15 versus 35CC
matched
SS234 versus 203370 versus 4201 versus 1.100noneMajor: none
Minor: NR
6.7% versus 7.5% pregnancy rate

Bedient et al. [26]
2000–2008
40 versus 41CC
adjusted
144 versus 161100 versus 250>2 days:12% versus 23%0 versus 5%2 versus 21/41 versus 8/40bleeding (1) versus bleeding (6), conversion (2)Major: 4 versus 2Bld tx (2), bowel injury (1), pelvic abscess (1) versus bld tx (2)
Minor: 3 versus 4
85% versus 83% symptom resolution

Ascher-Walsh and Capes [27]
2005–2008
75 versus 50HC(≤3 myomas)192 versus 138226 versus 4590.5 versus 3.300noneMajor: none
Minor: 2/75 versus 19/50febrile morbidity 1 versus 19

Barakat [28]
2008-2009
89 versus 393
89 versus 93
HC
HC
__
__
181 versus 126181 versus 1551 versus 3
1 versus 1 (median)
0
0 versus 1
DRS: 0
LSC: 2
OS: 25
DRS (0), LSC (1) (bowel injury), OS (0)
Intraoperative hemorrhage: NR
Major: DRS (0), LSC (0), OS (1) (wound separation)
Minor: DRS (0), LSC (1), OS (0)

Hysterectomy
Payne and Dauterive [29] 2006-2007100 versus 100
LSC = Type IVE
HCSS119 versus 9261 versus 1131 versus 1.64% versus 9%01/100 versus 2/100 cystotomy (1) versus enterotomy (1), vaginal tear (1)Major: none
Minor:1/100 versus 0

Shashoua et al. [30]
(2005–2007)
24 versus 44
LSC = Type IVE
HCSS142 versus 1221.9 versus 1.8 (hgb drop)1.0 versus 1.400noneMajor: 0 versus 1, cuff dehiscence
Minor: 1/24 versus 0

Sarlos et al. [31]
2007–2009
40 versus 150
LSC = TLH
HC
matched
SS109 versus 83<50 versus 813.3 versus 3.900noneMajor: none
Minor: 5/40 versus 0

Giep et al. [32]
2007–2009
237 versus 265
LSC = LAVH
CC & HCDS90 versus 12559 versus 1681.0 versus 1.21.7% versus 0.4%01/237 versus 1/265cystotomiesMajor: 2 versus 1
PE (1), abscess (1) versus abscess (1)
Minor: 6/237 versus 3/265

Sacrocolpopexy
Geller
et al. [33]
2004–2008
73 versus 105CCDS328 versus 225103 versus 2551.3 versus 2.71.4% versus 01 versus 41/73 versus 1/105 cystotomiesMajor: 1 versus 0
PE
Minor: 11/73 versus 11/105
Improvement in POP-Q C point at 6 m f/u

Historic controls (HCs), Concurrent controls (CCs), same surgeon(s) (SS), different surgeon(s) (DS), estimated blood loss (EBL), not reported (NR). Sample size (N). When not specified, DRS outcomes are reported first. Items in bold are significantly different determined by a two-sided alpha . Outcomes are reported as means unless otherwise noted.