Robotic Surgery in Gynecology: An Updated Systematic Review

Table 3

Comparative observational studies evaluating the da vinci robotic system (DRS) versus open surgery (OS) or Laparoscopy (LSC) to perform robotic radical hysterectomies (RRH), abdominal radical hysterectomies (ARH), or Laparoscopic radical hysterectomies (LRH) for cervical cancer and a comparative observational study of DRS versus OS and LSC to perform ovarian cancer staging and debulking surgeries.

Surgery

N

RRH versus ARH

RRH versus LRH

Control

Surg-eon

OR time (min.)

EBL (mL)

Hospital stay (days)

Lymph node count

Conversions

Bld Tx

Intraoperative complications

Postoperative complications

Radical hysterectomy

Magrina [92]; 2003–2006; Mayo ClinicPhoenix, AZ; Matched: age, BMI, malignancy, stage, type of radical

27 versus 35; 27 versus 31

✓

✓

HC + CC; HC + CC; Pro-Spective

NR

190 versus 167; 190 versus 220

133 versus 444; 133 versus 208

1.7 versus 3.6; 1.7 versus 2.4

26 versus 28; 26 versus 26

None

RRH: 4%; ARH:9%; LRH: 0%

RRH: 0; ARH: 6%; Bleeding (2); LRH: 3%; Rectotomy (1)

RRH: Major 7% Pleural effusions (1), pneumothorax (1); Minor: 15% urinary retention (1), UTI (2), bleeding (1); ARH: Major 9%; Pna (1), wound seroma (1), ileus (1)Minor: 9% urinary retention (1), emesis (2); LRH: Major 6%; Fever (1), port-site infection (1); Minor: 10% corneal abrasion (1), urinary retention (1), lymphatic drainage at cuff (1)

Boggess et al. [81]; 2005–2007; UNC; Matched: stage

51 versus 49

✓

HC; Pro-Spective

NR

211 versus 248

97 versus 417

1 versus 3.2

34 versus 23

None

RRH: 0%; ARH:8%

NR

RRH: 8%; Cuff abscess (1), lymphedema (1), readmission (1), cuff dehiscence (1); ARH: 16%; Femoral n. injury (2), ileus (1), lymphocyst (1), bleeding (1), cuff dehiscence (1), wound infection (2)

Geisler [93]; 2007-2008; Toledo, OH

30 versus 30

✓

HC; Pro-spective

NR

154 versus 166

165 versus 323

1.4 versus 2.8

25 versus 26

none

NR

NR

Urinary retention; POD no. 8; RRH: 27%; ARH: 3%; 90 days post-op: ND

Estape [94]; 2006–2008; South Miami Hospital; Matched: stage and histology

32 versus 14; 32 versus 17

✓

✓

HC; HC; Pro-spective

DS

144 versus 114; 144 versus 132

130 versus 621; 130 versus 210

2.6 versus 4.0; 2.6 versus 2.3

32 versus 26; 32 versus 19

NR

RRH: 3%; ARH: 36%; LRH: 0%

RRH: 3%; Cystotomy (1); ARH: 0%; LRH: 12%; Cystotomy (2)

RRH: 19%; Atelectasis/COPD (1), fever (1), ileus (1), wound cellulitis (1), pelvic abscess (1), cuff dehiscence (1)ARH: 29%; Pna (1), SVT (1), ureter dilation (1), urine retention (1); LRH: 24%; Fever (1), hypo-K (1), ileus (1), fistula (1)

Maggioni et al. [95]; 2007–2009; Milan, Italy

40 versus 40

✓

HC; Pro-spective

DS

272 versus 200

78 versus 221

3.7 versus 5.0

20 versus 26

NR

RRH: 8%; ARH: 23%

RRH: 5%; Nerve injury (1), intestinal injury (1); ARH: 10%; Cystotomy (1) ureteral injury (2), intestinal injury (2)

RRH: 30%; Subcutaneous emphysema (4), fever (3), infection (1), nerve palsy (2), pleural effusion (1), reintervention (1); ARH: 25%; Fever (12), infection (3), ileus (1), nerve palsy (3), pleural effusion (2), reintervention (1)

Nam et al. [96]; 2006–2009; Seoul, Korea; Matched: Age, BMI, stage, histology, prior surgeries, radical type

32 versus 32

✓

HC; Pro-Spective

DS

218 versus 209

220 versus 532

11.6 versus 16.9

20 versus 24

NR

RRH:  3%; ARH:  64%

RRH:  3%; Rectotomy; ARH: 0%

RRH: 84%; Infection (2), fever (7), pleural effusion (2), bladder dysfunction (5), ileus (4), diarrhea (1), wound dehiscence (1), neuropathy (1), lymphedema (1), readmit (2), ureteral stricture (1)ARH: 59%; Infection (1), fever (9), pleural effusion (1), bladder dysfunction (3), ileus (2), wound dehiscence (3)

Sert and Albert [97]; 2005–2009; Norway

35 versus 26; 35 versus 7

✓

✓

HC; HC; Pro-specitve

NR

263 versus 163; 263 versus 364

82 versus 595; 82 versus 164

3.8 versus 9.2; 3.8 versus 8.4

20 versus 26; 20 versus 15

NR

NR

RRH: 9%; Cystotomy (3)ARH: 0; LRH: 14%; Cystotomy (1)

RRH: 11%Lymphocyst (2), lymphedema (1), DVT (1); ARH: 46%Lymphocyst (1), lymphedema (2), UTI (7), pna (2),; LRH: 71%Lymphocyst (3), UTI (1), compartment syndrome (1)

Tinelli et al. [98]; 2003–2010; Avellino, Italy; & Mount Sinai, New York, NY

23 versus 76

✓

CC; Pro-spective

DS

255 versus 323

95 versus 157

4 versus 3

Pelvic: 27 versus 25; Aortic:12 versus 10

none

0

RRH: 9%; Cystotomy (2); LRH: 3%; Cystotomy (2)

RRH: 9%; Lymphorrhea (2), fever (2); LRH: 21%; Fistula (1), fever (6), lymphorrhea (9)

Ovarian cancer debulking

Magrina et al. [99]; 2004–2008; Mayo Clinic Phoenix, AZ; Matched: age, BMI, type debulking

25 versus 119; 25 versus 27

✓

✓

HC + CC; Pro-spective; HC + CC

NR

315 versus 261; 315 versus 254

164 versus 1307; 164 versus 267

4.2 versus 9.4; 4.2 versus 3.2

25 versus 23; 25 versus 21

NR

NR

DRS: 12%; Cystotomy (2), vessel injury (1); OS: 13%; Bleeding (6), GI injury (6), cystotomy (2), ureteral injury (2); LSC: 11%; Enterotomy (1), bleeding (1), vessel injury (1)

DRS: 24%; Cuf dehiscence (2), pleural effusion (1) bleeding (1), ileus (1), trocar-site infection (1), pulmonary edema (1); OS: 34%; Wound complications (10), GI (11), CV (7), pulmonary (7), UTI(2), abscess (2), hematoma (1), anastamotic leak → death (1); LSC: 4%; Pelvic abscess (1)

Hisoric conrols (HC), Concurrent controls (CC), 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 <0.05. Outcomes are reported as means unless otherwise noted.