• M Reza, S Maeso, J A Blasco, and E Andradas.
• Health Technology Assessment Unit, Laín Entralgo Agency, C/Gran Vía 27, 7°, Madrid 28013, Spain. mercedes.reza@salud.madrid.org
• Br J Surg. 2010 Dec 1; 97 (12): 1772-83.

BackgroundThe safety and effectiveness of robotic, open and conventional laparoscopic surgery in gynaecological surgery was assessed in a systematic review of the literature. This will enable the general surgical community to understand where robotic surgery stands in gynaecology.MethodsA search was made for previous systematic reviews in the Abstracts of Reviews of Effects, Health Technology Assessment, Cochrane Collaboration and Hayes Inc. databases. In addition, the MEDLINE, Embase and CINAHL databases were searched for primary studies. The quality of studies was assessed and meta-analyses were performed.ResultsTwenty-two studies were included in the review. All were controlled but none was randomized. The majority were retrospective with historical controls. The settings in which robotic surgery was used included hysterectomy for malignant and benign disease, myomectomy, sacrocolpopexy, fallopian tube reanastomosis and adnexectomy. Robotic surgery achieved a shorter hospital stay and less blood loss than open surgery. Compared with conventional laparoscopic surgery, robotic surgery achieved reduced blood loss and fewer conversions during the staging of endometrial cancer. No clinically significant differences were recorded for the other indications tested.ConclusionThe available evidence shows that robotic surgery offers limited advantages with respect to short-term outcomes. However, the clinical outcomes should be interpreted with caution owing to the methodological quality of the studies.Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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