Robot-assisted surgery in gynecological oncology: Current status and controversies on patient benefits, cost and surgeon conditions- A systematic review

INTRODUCTION: Robot-assisted surgery has become more widespread in gynecologic oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment.

MATERIAL AND METHODS: A database search in PubMed and EMBASE was performed up until March 4th 2016. The search strategy was developed in collaboration with an information specialist, and by application of the PRISMA guidelines. Human subjects and English language were the only restrictive filters applied. Selection was performed by screening of titles, abstracts and full text scrutiny. From 2001 to 2016, a total of 76 references were included.

RESULTS: Robot-assisted surgery in gynecologic oncology has increased, and current knowledge support that the oncologic safety is similar, compared to previous surgical methods. The controversies arise because current knowledge does not clearly document the benefit of robot-assisted surgery, on perioperative outcome compared with the increased costs of the acquisition and application.

CONCLUSION: The rapid development in robot-assisted surgery calls for long-term detailed prospective cohorts or randomized controlled trials. The costs associated with acquisition, application and maintenance, impact cost-benefit evaluations in an unfavorable direction especially when compared to laparoscopy. Future developments in robot-assisted surgery will hopefully lead to competition in the market, which will decrease costs. This article is protected by copyright. All rights reserved.