Revolutionizing Women’s Health: The Role of Robot-Assisted Surgery in Modern Obstetrics and Gynecology
Keywords:
robot-assisted surgery, gynecology, laparoscopy, perioperative outcomes, cost-effectiveness, obstetric applicationsAbstract
Background: Robot-assisted surgery (RAS) is now on the rise in gynecology and has tentatively entered few obstetric-adjacent operations. It is attractive for its dexterity and three-dimensional visualization, as well as for ergonomic benefits. Nevertheless, there remain some concerns about both cost-effectiveness and efficiency in operative techniques. The present review provides a summary of the available evidence comparing RAS with standard laparoscopy (CL) and open surgery (OS), considering perioperative performance outcomes and context.
Methods: Based on the PRISMA guidelines, our review included research reviewed in 22 studies published between 2013 and 2024, which included randomized controlled trial, cohort study and case–control study. Search terms: MEDLINE/PubMed, Scopus, and Web of Science. Eligible studies reported outcomes for gynecologic (benign or oncologic) and obstetric-adjacent procedures. Key metrics included operative time, estimated blood loss (EBL), length of stay (LOS), conversion rates, complications, transfusion, readmission and cost. Study quality was evaluated using Cochrane RoB 2 and the Newcastle–Ottawa Scale.
Results: RAS consistently exhibited lower EBL (≈110 mL) and shorter LOS (≈1.6 days) than both CL and OS across a sample of 7,630 patients. Conversion rates and complications, particularly in high-complexity cases, were lowered. Operative time was slightly longer with RAS (≈165 minutes) and this gap decreased with experience and suturing-intensive procedures. For RAS, direct procedural costs were highest (≈USD 9,800). Obstetric-adjacent applications, including interval cerclage and metroplasty, represent feasible alternatives but remain underexplored.
Conclusion: RAS represents incremental benefits over CL in complex gynecologic settings, though such superiority does mean a trade-off in operative time, and therefore time spent in the procedure. A selective, value-driven approach and further assessment of obstetric applications are suggested
