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Robotic-Assisted vs. Traditional Laparoscopic Hysterectomy for Benign Disease

Longer operating times and no clear advantage to robotic-assisted hysterectomy.

When feasible, vaginal or other minimally invasive approaches to hysterectomy for benign gynecologic conditions are preferred over abdominal surgery, but the question of whether robotic-assisted laparoscopy is superior to traditional laparoscopy remains unsettled. In a randomized trial involving 95 patients with benign disease, two Swiss gynecologic surgeons with experience in laparoscopic surgery assessed operating times, outcomes, and patients' quality of life associated with robotic-assisted versus conventional laparoscopic hysterectomy. For robotic surgeries, net operating time was defined as total time minus robot docking time, and corresponds to time devoted to the surgery itself.

In the robotic group, mean total operating time (106 minutes) and net operating time (96 minutes) were both significantly longer than operating time in the conventional group (75 minutes). Blood loss, complications, postsurgical use of analgesics, and number of days before return to daily activities and work were similar between groups, whereas quality-of-life scores were significantly better in the robotic group. No cases were converted to laparotomy, but one robotic case was completed by traditional laparoscopy.

Comment: Most studies of robotic-assisted laparoscopic hysterectomy have been retrospective; by contrast, these authors conducted a prospective randomized trial to demonstrate that, compared with the robotic approach, traditional laparoscopy was associated with shorter operating times and similar perioperative outcomes. Advocates of robotic assistance may claim that the operating time differential is explained by the relatively limited robotic experience of the surgeons, long docking times (mean, 20 minutes), and use of a first-generation robotics system with only two operative arms. However, the superior quality-of-life scores for robotic cases are difficult to explain, as analgesic use and time to resume daily activities were not statistically different between groups. The higher cost of robotic hysterectomy (an additional US$2600 per case [J Minim Invasive Gynecol 2010; 17:730]) adds to the authors' conclusion that, in experienced hands, "patients with a benign pathology should preferentially be treated by conventional laparoscopic hysterectomy."

— Brent E. Seibel, MD

Dr. Seibel is an Assistant Professor of Obstetrics and Gynecology at the University of Florida College of Medicine–Jacksonville.

Published in Journal Watch Women's Health October 4, 2012

Citation(s):

Sarlos D et al. Robotic compared with conventional laparoscopic hysterectomy: A randomized controlled trial. Obstet Gynecol 2012 Sep; 120:604.

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