The introduction of da Vinci Robotic Surgery to the field of Gynecology has resulted in large changes in surgical management. The robotic platform allows less experienced laparoscopic surgeons to perform more complex procedures. In general gynecology and reproductive gynecology, the robot is being increasingly used for procedures such as hysterectomies, myomectomies, adnexal surgery, and tubal anastomosis. Among urogynecology the robot is being utilized for sacrocolopexies. In the field of gynecologic oncology, the robot is being increasingly used for hysterectomies and lymphadenectomies in oncologic diseases. Despite the rapid and widespread adoption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches. Our aim is to update previously published reviews with a focus on only comparative observational studies. We determined that, with the right amount of training and skill, along with appropriate patient selection, robotic surgery can be highly advantageous. Patients will likely have less blood loss, less post-operative pain, faster recoveries, and fewer complications compared to open surgery and potentially even laparoscopy. However, until larger, well-designed observational studies or randomized control trials are completed which report long-term outcomes, we cannot definitively state the superiority of robotic surgery over other surgical methods. 1. Background Minimally invasive surgery (MIS) has revolutionized the management of gynecologic disorders over the last 30 years. However, the most substantial improvements have come with the advent of robotic surgery. Initially, traditional laparoscopy afforded less invasive approaches to hysterectomies, tubal ligations, adnexal surgery, and even lymphadenectomies and radical hysterectomies. However, not all surgeons are comfortable with the laparoscopic approach due to its steep and extended learning curve, nor are all patients and procedures amenable to traditional laparoscopy. In fact, the majority of advanced gynecologic surgeries are still being performed through an abdominal incision. A recent study looking at the rates of open versus vaginal or laparoscopic hysterectomies from 2000 to 2005 at teaching and nonteaching hospitals in Illinois revealed that teaching hospitals were significantly less likely to perform abdominal hysterectomies (OR 0.69) after adjusting for confounding variables, but the overall rates of abdominal hysterectomies at teaching and nonteaching hospitals were still 82% and 77%, respectively [1].
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