Robotic surgery in Gynecology: the present and the future

Comparison of the Outcomes of Enhanced Recovery After Surgery and Traditional Recovery Pathway in Robotic Hysterectomy for Benign Indications: A Randomized Controlled Trial

STUDY OBJECTIVE

The present study aimed to evaluate the impact of the implementation of the enhanced recovery after surgery (ERAS) program in patients undergoing robotic hysterectomy for benign indications in comparison with conventional management.

DESIGN

Randomized controlled trial.

SETTING

North Indian tertiary care hospital.

PARTICIPANTS

Patients aged 40 to 60 years willing to sign the informed written consent were included, whereas cases with contraindications for neuraxial anesthesia were excluded. A total of 130 subjects undergoing robotic hysterectomy were divided into ERAS (n = 65) and conventional (non-ERAS) (n = 65) groups.

INTERVENTIONS

Components of the ERAS protocol included preoperative counseling, carbohydrate loading, early removal of catheter, and early ambulation. Both groups underwent optimization of medical conditions, standardized anesthesia, and venous thromboembolism prophylaxis.

MEASUREMENTS AND MAIN RESULTS

Outcome measures included length of hospital stay (LOHS), time to tolerance of diet, postoperative complications, readmission rates, and quality of life assessed by WHO-QOL BREF. Baseline characteristics were comparable between groups. ERAS group showed significantly lower docking time (4.82 ± 0.73 vs 5.31 ± 0.92 minutes), faster tolerance of diet (0.14 ± 0.35 vs 1.14 ± 0.35 days), and earlier resumption of ambulation (0.42 ± 0.5 vs 1.26 ± 0.44 days). Time for "fit for discharge" (1.43 ± 0.61 vs 2.97 ± 1.1 days) and LOHS (2.85 ± 1.09 vs 3.78 ± 1.29 days) were significantly lower in the ERAS group. Postoperative complications and readmission rates were comparable. Quality-of-life scores favored the ERAS group at postoperative days 1 and 30.

CONCLUSION

The combination of ERAS and robotic surgery improves patient outcomes, shortens hospital stays, and enhances postoperative recovery without increasing complications. This research serves as a pioneering effort in assessing the impact of ERAS on robotic hysterectomy for benign indications, providing valuable insights for future multicentric studies and supporting the integration of ERAS protocols to enhance patient outcomes and quality of life.

Efficacy between Conventional Laparoscopy and Robotic Surgery in Mexican Patients with Endometriosis: A Comparative Study

Background. Surgical management of endometriosis is essential, and deep endometriosis involves the invasion of endometrial tissue into other organs such as the bladder, ureters, and rectum. In Latin American countries, significant expertise has been achieved in conventional laparoscopy (CL); however, there is less experience in robot-assisted laparoscopy (RAL) because of the high cost of this technique. For this reason, studies comparing CL and RAL for the treatment of deep endometriosis in patients are scarce, making this study the first to share the experience of Mexican patients. Aim. The efficacy of CL vs. RAL in the management of deep endometriosis in Mexican patients was compared. Materials and Methods. We performed a retrospective and comparative study. We considered all patients treated with minimally invasive surgery for deep endometriosis between 2015 and 2023. Results. A total of 93 patients were included; 56 patients were treated with CL, and 37 patients were treated with RAL. A significant difference (p < 0.05) was observed in the postoperative length of stay, which was longer in patients treated with CL compared with those treated with RAL. Additionally, postoperative pain was less frequent in patients treated with RAL than in those treated with CL (p < 0.05). We did not observe a significant difference in operative time, blood loss, or perioperative complications between the two surgical techniques (p < 0.05). Conclusions. CL and RAL are effective methods for managing endometriosis in Mexican patients; however, RAL is beneficial for the treatment of deep endometriosis because patients experience postoperative pain less frequently than CL patients and have a shorter postoperative length of stay.

Robotic sacrocolpopexy

Pelvic organ prolapse (POP) is a common cause of gynecological disease in elderly women. The prevalence of POP has increased with an aging society. Abdominal sacrocolpopexy (ASC) is safer and more effective than the vaginal approach in patients with apical compartment POP because it has a higher anatomical cure rate, a lower recurrence rate, less dyspareunia, and improved sexual function. Laparoscopic sacrocolpopexy (LSC) has replaced ASC. Robotic sacrocolpopexy (RSC) also helps overcome the challenges of LSC by facilitating deep pelvic dissection and multiple intracorporeal suturing. The RSC is technically easy to apply, has a steep learning curve, and offers many advantages over the LSC. However, insufficient data led us to conclude that the LSC is superior overall, especially in terms of costeffectiveness. The present review provides insights into different aspects of RSC, highlighting the most common benefits and concerns of this procedure. We searched for eligible articles discussing this issue from January 2019 to March 2022 to reveal the outcomes of RSC.

Clinical relevance of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecology

This study reviews the progress and recent advances in vaginal natural orifice transluminal endoscopic surgery (vNOTES) as a minimally invasive gynecologic procedure. The proposed advantages of vaginal natural orifice transluminal surgery include enhanced cosmesis due to a scarless procedure, better exposure compared with the pure vaginal approach, tolerable pain scores, fewer perioperative complications, and a shorter hospital stay. Recent advances in surgical instrumentation and technology have improved the feasibility of vNOTES as an innovative treatment option for gynecological conditions. However, technical challenges and training issues must be overcome before its widespread use. As a promising surgical innovation, further randomized comparative studies are required to clarify the safety and effectiveness of vNOTES in gynecology.