A Systematic Literature Review and Meta-Analysis Comparing Robotic-Assisted Surgery Using the Da Vinci Surgical Systems for Benign Gynecological Procedures to Laparoscopic or Open Approach

OBJECTIVES: Robotic-assisted surgery use is increasing for benign gynecologic procedures. We reviewed the evidence across three benign procedures to understand the clinical value of robotic-assisted surgery and present the meta-analysis results.

METHODS: A PRISMA-guided literature review and a meta-analysis assessed studies where robotic-assisted surgery was compared to laparoscopic or open approach in benign hysterectomy (BH), myomectomy (MYO), and endometriosis resection (ER). A PubMed, Embase, and Scopus search spanning a 12 year period was performed. Studies were excluded if non-English language, pediatric cases, malignancies, absence of relevant outcomes, or redundant data. Key outcomes assessed included operative time, conversions, transfusions, hospital stay, postoperative complications, reoperations, and readmission within 30-days of surgery.

RESULTS: The search identified 30 publications on BH, 22 on MYO, and 9 on ER. Compared to laparoscopic surgery, patients undergoing robotic-assisted benign gynecologic surgery were 60% less likely to be converted (OR=0.40[0.23,0.71], p=0.002), were 13% less likely to experience a complication (OR=0.87[0.77,0.9951], p=0.04), and were 20% less likely to receive a transfusion (OR=0.80[0.70,0.93], p=0.003). There were no differences in hospital stay, readmissions or reoperations. Operative time was longer for robotic-assisted benign gynecologic surgery by 34 min. Compared to open surgery, patients undergoing robotic-assisted benign gynecologic surgery were 73% less likely to receive a transfusion (OR=0.27[0.15, 0.50], p<0.0001), were 53% less likely to experience a complication (OR=0.47[0.37, 0.59], p<0.0001), and had on average shorter length of stay by 1.5 days. There were no differences in operative time, readmissions, or reoperations.

CONCLUSIONS: The meta-analysis of available evidence demonstrates that using da Vinci surgical system for benign gynecologic surgery results in lower conversion rates, less transfusions, and less postoperative complications. This analysis represents a holistic approach to evaluating evidence within benign gynecologic procedures. These findings can help regulators and decision makers evaluate robotic-assisted surgery for benign gynecologic procedures.