Gyne Robot Surg Search

CLOSE


Gyne Robot Surg > Volume 5(1); 2024 > Article
Kim: Robotic surgery: Still competing with laparoscopic surgery?
One of the most important improvements in minimally invasive gynecological surgery has been the introduction of robotic surgery.
Since robotic hysterectomy was first reported in 2002 [1]. Robotic surgery has a large share in most areas of gynecological surgery due to its many advantages such as learning curve and precision, and its use is accelerating [2,3]. There are many studies showing that robot is more advantageous than laparoscopic surgery in obese patients and patients with high surgical difficulty [4-6].
Robotic surgery also has some disadvantages. The biggest problems are longer surgical times and higher costs. [7-9] Of course, docking time can be reduced with a lot of experience, but the increase in cost has still not been resolved in many countries. For hysterectomy, the average cost of robotic surgery is 1.5 to 3 times higher than the average cost of laparoscopic surgery [10]. The purchase cost of robotic devices, maintenance costs, and consumable costs per case are the three main reasons for the increase in the cost of robotic procedures. However, it is believed that an increase in frequency of use and a decrease in equipment production costs may reduce the average cost in the long run.
There have been two debates related to robotic gynecologic surgery in Korea.
First, in many papers to date, most of the conclusions are that robotic surgery is better than laparoscopy when looking at surgical indicators, but that there is no significant difference. The conclusion of most papers was like “surgical outcomes of robotic and laparoscopic hysterectomy were comparable in terms of EBL, first gas discharge and hospital stay. Operation time was longer for robotic hysterectomy.” If so, some gynecological surgeons could wonder whether, considering the cost, they should recommend laparoscopic rather than robotic surgery to the patients, especially for very simple gynecological surgeries such as BSO. Even some patients are complaining that hospitals recommend robotic surgery to make money.
Second, it is a hybrid surgery that involves both robotic and laparoscopic surgery. For example, in the case of uterine myomectomy, the myoma is removed through laparoscopic surgery, and the uterine suture is performed by a robot. There are some desirable aspects of both surgeries in terms of taking advantage of both and minimizing their disadvantages. However, because the cost difference between the two surgeries is very large, there may be a tendency to prefer hybrid surgery even though laparoscopic surgery is possible. In particular, operators with little experience in robotic surgery tend to perform most surgeries laparoscopically and use robots to a minimum.
These debates come usually from unexperienced robotic surgeon. As experience with robotic surgery increases, surgeons’ eyes open to the many advantages of robots, and they confidently recommend robotic surgery to patients.
To solve these problems, the Korean Society of Robotic Gynecology Surgery (SKRGS) has developed and is implementing a proctoring system that matches the beginners and experts in robotic surgery and plans to introduce a robot certificate. Also, we plan to actively promote the benefits of robotic surgery to patients.
I hope all gynecologists who love robotic surgery can perform happy surgeries.

Notes

Conflict of interest

No potential conflict of interest relevant to this article was reported.

References

1. Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C Jr. Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc 2002;16:1271–3.
crossref pmid pdf
2. Sandadi S, Gadzinski JA, Lee S, Chi DS, Sonoda Y, Jewell EL, et al. Fellowship learning curve associated with completing a robotic assisted total laparoscopic hysterectomy. Gynecol Oncol 2014;132:102–6.
crossref pmid
3. Seamon LG, Fowler JM, Richardson DL, Carlson MJ, Valmadre S, Phillips GS, et al. A detailed analysis of the learning curve: robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Gynecol Oncol 2009;114:162–7.
crossref pmid
4. Orady M, Hrynewych A, Nawfal AK, Wegienka G. Comparison of robotic-assisted hysterectomy to other minimally invasive approaches. JSLS 2012;16:542–8.
crossref pmid pmc
5. Nawfal AK, Orady M, Eisenstein D, Wegienka G. Effect of body mass index on robotic-assisted total laparoscopic hysterectomy. J Minim Invasive Gynecol 2011;18:328–32.
crossref pmid
6. Orady ME, Karim Nawfal A, Wegienka G. Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes. J Robot Surg 2011;5:267–72.
crossref pmid pdf
7. Paraiso MF, Ridgeway B, Park AJ, Jelovsek JE, Barber MD, Falcone T, et al. A randomized trial comparing conventional and robotically assisted total laparoscopic hysterectomy. Am J Obstet Gynecol 2013;208:368.e1–7.
crossref pmid
8. Sarlos D, Kots L, Stevanovic N, von Felten S, Schär G. Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol 2012;120:604–11.
pmid
9. Lönnerfors C, Reynisson P, Persson J. A randomized trial comparing vaginal and laparoscopic hysterectomy vs robot-assisted hysterectomy. J Minim Invasive Gynecol 2015;22:78–86.
crossref pmid
10. Tapper AM, Hannola M, Zeitlin R, Isojärvi J, Sintonen H, Ikonen TS. A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions. Eur J Obstet Gynecol Reprod Biol 2014;177:1–10.
crossref pmid
TOOLS
Share :
Facebook Twitter Linked In Google+ Line it
METRICS Graph View
  • 0 Crossref
  •    
  • 172 View
  • 5 Download
Related articles in Gyne Robot Surg


ABOUT
ARTICLE CATEGORY

Browse all articles >

BROWSE ARTICLES
EDITORIAL POLICY
AUTHOR INFORMATION
Editorial Office
Department of Obstetrics and Gynecology, The Catholic University of Korea Seoul St. Mary's Hospital 9F, 222 Banpo-daero, Seocho-Gu, Seoul 06591, Korea
Tel: +82-53-258-4847    Fax: +82-53-258-4848    E-mail: grsjournal.office@gmail.com                

Copyright © 2024 by Society of Korean Robotic Gynecologic Surgery.

Developed in M2PI

Close layer
prev next