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Robotic-Assisted Hysterectomy for Endometrial Cancer Compared With Traditional Laparoscopic and Laparotomy Approaches: A Systematic Review

Gaia, Giorgia MD; Holloway, Robert W. MD; Santoro, Luigi MS; Ahmad, Sarfraz PhD; Di Silverio, Elena MD; Spinillo, Arsenio MD

doi: 10.1097/AOG.0b013e3181f74153

OBJECTIVE: To summarize comparative studies describing clinical outcomes of robotic-assisted surgeries compared with traditional laparoscopic or laparotomy techniques for the treatment of endometrial cancer.

DATA SOURCES: Using search words “robotic hysterectomy” and “endometrial cancer,” 22 citations were identified from Medline and PubMed (2005 to February 2010).

METHODS OF STUDY SELECTION: We selected English language studies reporting at least 25 robotic cases compared with laparoscopic or laparotomy cases that also addressed surgical technique, complications, and perioperative outcomes. Patients underwent total hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy.

TABULATION, INTEGRATION, AND RESULTS: Eight eligible comparative studies were identified that included 1,591 patients (robotic=589, laparoscopic=396, and laparotomy=606). Pooled means of the resected aortic lymph nodes for robotic hysterectomy and laparoscopy were 10.3 and 7.8 (P=.15), and robotic hysterectomy and laparotomy were 9.4 and 5.7 (P=.28). Pooled means of pelvic lymph nodes for robotic and laparoscopic hysterectomy were 18.5 and 17.8 (P=.95) and 18.0 compared with 14.5 (P=.11) for robotic hysterectomy compared with laparotomy. Estimated blood loss was reduced in robotic hysterectomy compared with laparotomy (P<.005) and laparoscopy (P=.001). Length of stay was shorter for both robotic and laparoscopic cases compared with laparotomy (P<.01). Operative time for robotic hysterectomy was similar to laparoscopic cases but was greater than laparotomy (P<.005). Conversion to laparotomy for laparoscopic hysterectomy was 9.9% compared with 4.9% for robotic cases (P=.06). Vascular, bowel, and bladder injuries; cuff dehiscence; and thromboembolic complications were similar for each surgical method. Transfusions for robotic hysterectomy compared with laparotomy was 1.7% and 7.2% (P=.06) and robotic hysterectomy compared were laparoscopy was 2.6% and 5.0% (P=.22).

CONCLUSION: Perioperative clinical outcomes for robotic and laparoscopic hysterectomy appear similar with the exception of less blood loss for robotic cases and longer operative times for robotic and laparoscopy cases.

Comparative studies indicate that robotic-assisted hysterectomy and laparoscopic hysterectomy for patients with endometrial cancer have similar perioperative outcomes and that both have less morbidity than laparotomy.

From the Department of Obstetrics and Gynaecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy; the Florida Hospital Cancer Institute and Global Robotics Institute, Orlando, Florida; and the Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.

Corresponding author: Robert W. Holloway, MD, Giorgia Gaia, MD, or Sarfraz Ahmad, PhD, Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, 2501 N Orange Avenue, Suite 800, Orlando, FL 32804; e-mail:

Financial Disclosure Dr. Holloway received training and speaker's honoraria from Intuitive Surgical, Inc. The other authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.