Boggess et al. compared 103 robotic patients with 81 laparoscopy patients and 138 laparotomy patients (41). The operating times for robotic and laparoscopy procedures were similar, but longer than laparotomy (191.2 minutes, 213.4 minutes, and 146.5 minutes, respectively). The blood loss, hospital stay, and number of nodes were all improved for the robotic group. Bell et al. compared a group of 40 robotic patients with 30 patients operated by laparoscopy and 40 patients operated by laparotomy (40). Robotic and laparoscopy operating times were comparable (184 minutes and 171 minutes, respectively) and longer than laparotomy (108.6 minutes). Blood loss was similar to laparoscopy, and both were lower than the laparotomy group. The number of lymph nodes removed was similar among the three groups. Postoperative complications were lower in the robotic group compared to the other two groups (7.5%, 27.5%, and 20%, respectively).
Another study evaluated the results of robotics and conventional laparoscopy for obese and morbidly obese patients (BMI 30–60) with endometrial cancer (42). Robotics was found to be preferable to the laparoscopic approach because of a shorter operative time, reduced blood loss, increased number of lymph nodes removed, and shorter hospital stay. The benefits of robotics for obese patients was noted with simple robotic hysterectomy, where the operating time remained unchanged in spite of the patient’s increased BMI (6). This may result from the absent awareness of the resistance of the robotic instruments being inserted through a thick abdominal wall because of the lack of tactile feedback.
The application of robotics for endometrial cancer can result in improvements of the perioperative outcomes (43). The operating time decreased by 47 minutes, vaginal cuff delayed healing decreased from 16% to 0%, and the number of pelvic and aortic lymphadenectomies and number of nodes retrieved increased per quarter analyzed from the initiation of robotics.
The increased costs of this technology is a criticism of robotics. Because cost is tied to frequency of use, when used on a regular basis the cost becomes similar to laparoscopy and less expensive than laparotomy as a result of shorter hospital stay. A comparison study of costs for robotics, conventional laparoscopy, and laparotomy for endometrial cancer showed a significantly reduced cost for robotics and laparoscopy compared to laparotomy and comparable costs for robotics and laparoscopy (40).
Early Cervical Cancer Robotic and laparoscopic radical hysterectomy may provide patient benefits over a laparotomy approach relative to blood loss, blood transfusions, and length of hospital stay. Operating times and postoperative complications are lower or similar (46–52). Recurrence and survival rates remain unchanged when comparing the results of both techniques (46–48,51,52). A prospective randomized trial is under way comparing laparoscopic or robotic radical hysterectomy with laparotomy (53).
The surgical technique for robotic radical hysterectomy is described elsewhere (54). A rapid learning curve is noted with robotic radical hysterectomy, with a 44-minute reduction in operating time after the first 34 procedures in association with a low complication rate and high nodal count (55).
In several retrospective studies comparing laparotomy with robotic radical hysterectomy, there was a shorter, similar, or longer operating time; reduced blood loss; shorter hospital stay; lower, similar, or higher number of lymph nodes removed; and similar rate of postoperative complications (49,56–58). In comparison with laparoscopy, robotics is associated with a shorter, similar, or longer operating time; reduced blood loss; shorter hospital stay; similar or lower postoperative complications; and comparable or higher number of nodes (49,50,57).