Robotic sacrocolpopexy may be preferable to laparotomy because of improved perioperative outcomes and similar anatomical results. A comparison of 73 robotic with 105 laparotomy sacrocolpopexies for vaginal and uterine prolapse revealed a longer operating time (328 vs. 225 minutes) but reduced blood loss (103 vs. 255 mL) and shorter hospital stay (1.3 vs. 2.7 days) for the robotic group. Anatomical improvement was similar for both groups as determined by pelvic organ prolapse quantification (POP-Q) C point (−9 vs. −8) (see Chapter 27) (32). Late complications, such as erosion rate and long-term anatomical results of robotic sacrocolpopexy are unknown.
Studies show the feasibility of robotics for the treatment of patients with cervical, endometrial, tubal, and ovarian cancer, with apparent similar or better perioperative outcomes, compared to conventional laparoscopy and with improved outcomes compared to laparotomy (33–39). A survey of Society of Gynecologic Oncologists members indicated 24% are regular users of robotics and 66% believed their use would increase (33).
Endometrial Cancer Laparoscopy provides similar or longer operative times, less blood loss, fewer postoperative complications, shorter hospital stay and recovery times, with similar recurrence and survival rates compared to laparotomy (34–39). Robotic technology may be preferable to conventional laparoscopy in selected patients for surgery for endometrial cancer, especially in morbidly obese patients. In expert hands, the use of minimally invasive techniques—laparoscopy and robotics— may facilitate the operations.
Studies comparing robotics to laparotomy suggest improved perioperative outcomes for robotics. Operative times are similar or longer, blood loss and hospital stay are reduced, the number of lymph nodes is comparable or higher, and postoperative complications are similar or decreased with robotics (15–17,40–44). Studies comparing robotics with conventional laparoscopy for endometrial cancer show similar or superior results for robotics. Some showed reduced blood loss, shorter hospital stay, increased lymph node yield, and lower morbidity with robotics compared to conventional laparoscopy (41). Others reported longer operating time but reduced blood loss, lower transfusion rate, lower conversion rate to laparotomy, and reduced hospital stay, even though the robotic patients had a higher BMI compared to laparoscopy (44). Robotics, as with laparoscopy, resulted in a shorter recovery time for endometrial cancer patients compared to laparotomy (40,45).
In an initial review of 38 patients with robotics operations, the perioperative outcomes were similar to patients treated by laparoscopy (n = 22). Results were similar to patients treated by laparotomy (n = 16) other than a larger blood loss and longer hospital stay for this group of patients. The operating times were similar for the three groups, blood loss was lower for the robotic and laparoscopy groups (283, 222, and 517 mL), and length of hospital stay was shorter for the robotic and laparoscopy groups (2, 2.5, and 6 days). There was no difference relative to the number of lymph nodes removed (18.4, 26.3, and 18.4, for robotics, laparoscopy, and laparotomy, respectively), number of lymph node metastases, positive cytological findings, or tumor recurrence. Postoperative complications were comparable among the three groups.