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Robotic vs Laparoscopic Hysterectomy: Is Robot Superior?

competence, a surgeon can create three robotic cases prior accommodate the culmination of extra-technically
to scheduled training in an animal lab at various robotic- demanding cases that would otherwise have required
training centers so that he or she immediately implements laparotomy. Third, robotic surgery has become the topic of
the training and reinforces what he/she learns inside the extensive marketing not just in surgeons and hospitals, but
animate or cadaver lab. The volume of mentored patient also to medical consumers. 15 The potential effect on this
procedures resulting in independent practice varies from marketing may be the topic of numerous reports. 16 The
institution to institution and will be likely individualized improved use of laparoscopic hysterectomy is noted almost
based on surgical experience and technical ability. solely at hospitals where robotic surgical procedures are
Additionally, many institutions are imposing a certain not performed 16 and also this may be due to competitive
volume of cases to ensure that they maintain a competent pressures or even an increased awareness and appreciation
level of skill, although individual differences in acquiring of minimally invasive surgical options for hysterectomy.
skills make an arbitrary number of completed cases illogical. Robotic surgery is of enormous interest for future years
Further, performance of one type of pelvic surgery does not and in my opinion will significantly influence minimal
mean another type of pelvic procedure can be performed access surgical procedures. Robotic surgery is still in its
safely. Credentialing requirements vary among institutions infancy and I believe that further improvements in
and many institutions are in the process or have recently technology and costs are needed. Furthermore, technical
advances such as reducing bulkiness, better suturing
established criteria for credentialing surgeons to perform
procedures on robotic platforms. techniques and implementation of learning software/
Surgical learning curves depend on two elements of simulators and teaching consoles, robotic surgery may help
in its endemic use. Multiple issues concerning the use of
surgical volume: total number of procedures performed and
robotics in gynecology remain. Short-and long-term patient
the time interval between procedures. Proficiency in a new
outcomes must be further evaluated with randomized
procedure includes the procedure itself and also the ability
prospective trials. Surgical costs, considering postoperative
to manage complications. Furthermore, safe surgical practice
variables, need critical review.
also is dependent upon continued surgical volume after
training, equally as for laparoscopic hysterectomy.
CONCLUSION
Additionally, most experts agree that the surgeon must be
competent in performing a procedure via laparoscopy before Clinical outcomes for both the robotic and conventional
learning a robotic approach. However, there may come a laparoscopic hysterectomy are equivalent. Cost and
time in the future that many open surgeries are converted to operative time for the robotic-assisted hysterectomy is higher
robotic surgery and therefore, trainees will perform a certain than that of conventional laparoscopic hysterectomy. As
procedure solely with robot-assisted. technical evolution has always influenced surgery during
Robotic surgical procedures are expensive. The da the past, I do believe that robotic surgery has enormous
Vinci® system currently costs over $1.75 million, each technical potential to play a crucial role in the next decade.
instrument attached to the robotic arm costs between $2200 However, until randomized controlled studies of
and $3200 and requires replacement after 10 uses. Costs comparative effectiveness are conducted to further decisions
regarding the diffusion of robotic in conventional
incurred by robotic surgery include capital acquisition,
laparoscopic hysterectomy, I cannot definitively state the
limited use instruments, team training expenses, equipment
superiority of robotic over conventional hysterectomy.
maintenance, equipment repair, and operating room set-up time.
As noted above, robot-assisted cases cost approximately
ACKNOWLEDGMENTS
$2000 more per case as opposed to same procedure
accomplished by conventional laparoscopic procedure. Project submitted as part of fulfilment for the award of
Inside the era of healthcare reform, this elevated cost will Minimal Access Surgery Diploma to World Laparoscopy
be the greatest detriment to continued implementation of Hospital, New Dehli, India. Period: April 2013.
robotic surgery. More prospective research is required to
REFERENCES
analyze overall costs (direct and indirect) of robot-assisted
procedures to medical care systems. 15 1. Soto E, Loy Y, et al. Total laparoscopic hysterectomy versus da
The rapid uptake of robotic hysterectomy is likely to be Vinci robotic hysterectomy: Is using the robot beneficial?
J Gynecol Oncol 2011 Dec;22(4):253-259.
as result of a variety of factors. First, robotic surgery could
2. Orady M, Hrynewych A, et al. Comparison of robotic-assisted
be easier to learn than laparoscopy because it is more analogs hysterectomy to other minimally invasive approaches. JSLS 2012
to traditional open surgery. Second, robotic assistance may Oct-Dec;16(4):542-548.
World Journal of Laparoscopic Surgery, September-December 2013;6(3):163-166 165