Robotic Surgery

Why we don’t perform robotic surgery

On March, 2015 the American Collage of Obstetricians and Gynecologists and the Society of Gynecologic Surgeons published a Committee Opinion about robot-assisted surgeries in gynecology. This evidence based document is confirming that robot-assisted surgeries in gynecology are not supported by high-quality patient outcomes, safety, or cost data.

 

Summary of Current Evidence

The rapid adoption of robotic technology for gynecologic surgery is not supported by high-quality patient outcomes, safety, or cost data. A wide array of literature exists, but most studies are retrospective, observational, and non-comparative. Four RCTs compared robot-assisted surgery for benign gynecologic disease with laparoscopy, and none showed any benefit from using the robotic approach. These and other studies show that robot-assisted gynecologic surgery can be performed safely in centers with experienced surgeons and that this minimally invasive approach could be considered for procedures that might otherwise require laparotomy. For gynecologic oncology surgery, there are no data from RCTs. Well-designed RCTs or comparably rigorous nonrandomized prospective trials are needed to determine which patients are likely to benefit from robot-assisted surgery and to establish the potential risks. Adoption of new surgical techniques should be driven by what is best for the patient, as determined by evidence-based medicine rather than external pressures. As with any procedure, adequate informed consent should be obtained from patients before surgery. In the case of robotic procedures, this includes a discussion of the indications for surgery and risks and benefits associated with the robotic technique compared with alternative approaches and other therapeutic options.

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