Comparison between learning curves of robot-assisted and laparoscopic surgery in gynaecology: a systematic review.

D Raimondo, A Raffone, D Neola, L de Landsheere, R A de Leeuw, L Mereu, T Badotti, E Pazzaglia, R Seracchioli, G Scambia, F Fanfani
Author Information

Abstract

Background: The advantages and disadvantages of Robotic Laparoscopic Surgery (RLS) compared to other minimally invasive surgical approaches are debated in the literature.
Objective: To evaluate the learning curves (LC) and their assessment methods for Robotic Laparoscopic Surgery (RLS) and Laparoscopic Surgery (LPS) in gynaecologic procedures.
Materials and Methods: A systematic review of the literature was performed including the English language observational or interventional studies reporting the absolute number of procedures needed to achieve competency in RLS and LPS gynaecologic procedures, along with an objective and reproducible LC assessment method.
Main outcome measures: Number of procedures needed to achieve competency in RLS and LPS and LC assessment methods were extracted from included studies.
Results: Six studies with a total of 545 women were included. Several surgical procedures and methods for LC assessment were assessed in the included studies. For radical hysterectomy, bilateral salpingo-oophorectomy and lymph node dissection, the minimum number of procedures required to reach the LC was smaller in RLS than LPS in two studies out of four. For sacrocolpopexy, the number of procedures required to reach the LC was lower in RLS and LPS in one study out of two.
Conclusion: RLS learning curve was reported to be quicker than that of LPS for radical hysterectomy, bilateral salpingo-oophorectomy and lymph node dissection. However, a standardised and widely accepted method for LC assessment in endoscopic surgery is needed, as well as further randomised clinical trials, especially involving inexperienced surgeons.
What is new?: This study may be the first systematic review to evaluate the LCs and their assessment methods for RLS and LPS in gynaecologic procedures.

References

  1. Am J Obstet Gynecol. 2008 Jun;198(6):649.e1-4 [PMID: 18538146]
  2. ANZ J Surg. 2003 Sep;73(9):712-6 [PMID: 12956787]
  3. J Endourol. 2021 Oct;35(10):1483-1489 [PMID: 33559522]
  4. BMC Cancer. 2020 Feb 24;20(1):152 [PMID: 32093687]
  5. Int J Surg. 2015 Feb;14:12-6 [PMID: 25560749]
  6. BJOG. 2023 Jan;130(1):e1-e8 [PMID: 35844092]
  7. Curr Opin Obstet Gynecol. 2016 Aug;28(4):304-10 [PMID: 27362711]
  8. Clin Obstet Gynecol. 2011 Sep;54(3):376-81 [PMID: 21857168]
  9. Rev Assoc Med Bras (1992). 2022 Nov 28;68(11):1514-1518 [PMID: 36449767]
  10. Postgrad Med J. 2007 Dec;83(986):777-9 [PMID: 18057179]
  11. Taiwan J Obstet Gynecol. 2017 Dec;56(6):781-787 [PMID: 29241920]
  12. Surg Endosc. 2018 Jun;32(6):2683-2688 [PMID: 29214515]
  13. Gynecol Oncol. 2011 Mar;120(3):413-8 [PMID: 21194735]
  14. ISRN Obstet Gynecol. 2012;2012:569456 [PMID: 22973522]
  15. Obstet Gynecol Sci. 2018 Jul;61(4):468-476 [PMID: 30018901]
  16. Int J Med Robot. 2012 Dec;8(4):496-503 [PMID: 23086802]
  17. Gynecol Surg. 2010 Sep;7(3):253-258 [PMID: 20700514]
  18. J Minim Invasive Gynecol. 2016 Jan;23(1):84-8 [PMID: 26321172]
  19. J Cancer. 2016 Nov 25;7(15):2304-2308 [PMID: 27994668]
  20. Surg Endosc. 2016 Jan;30(1):11-23 [PMID: 25840896]
  21. Eur Urol Open Sci. 2022 Oct 26;46:45-52 [PMID: 36506259]
  22. Int J Med Robot. 2022 Jun;18(3):e2385 [PMID: 35236012]
  23. Ceska Gynekol. 2017 Fall;82(4):261-267 [PMID: 28925269]
  24. BJOG. 2021 Feb;128(3):563-571 [PMID: 32627934]
  25. BMC Surg. 2021 Oct 28;21(1):379 [PMID: 34711220]
  26. Syst Rev. 2015 Jan 01;4:1 [PMID: 25554246]
  27. J Minim Access Surg. 2019 Jan-Mar;15(1):8-13 [PMID: 29582799]
  28. Int J Gynecol Cancer. 2013 Jul;23(6):1145-9 [PMID: 23748178]
  29. J Surg Oncol. 2015 Dec;112(7):684-9 [PMID: 26289120]
  30. J Robot Surg. 2009 Oct;3(3):179 [PMID: 27638376]
  31. Surg Endosc. 2016 Sep;30(9):3749-61 [PMID: 26675938]
  32. J Minim Invasive Gynecol. 2010 Nov-Dec;17(6):739-48 [PMID: 20955983]
  33. Minim Invasive Ther Allied Technol. 2022 Aug;31(6):815-824 [PMID: 34989636]
  34. Int J Med Robot. 2016 Mar;12(1):114-24 [PMID: 25753111]
  35. J Robot Surg. 2013 Sep;7(3):295-9 [PMID: 27000926]
  36. Cochrane Database Syst Rev. 2015 Aug 12;(8):CD003677 [PMID: 26264829]
  37. Female Pelvic Med Reconstr Surg. 2012 Mar-Apr;18(2):122-6 [PMID: 22453324]
  38. Arch Gynecol Obstet. 2022 Nov;306(5):1555-1561 [PMID: 35767099]

Word Cloud

Created with Highcharts 10.0.0RLSproceduresLCLPSassessmentstudiesmethodsLaparoscopicSurgerylearninggynaecologicsystematicreviewnumberneededincludedRoboticsurgicalliteratureevaluatecurvesachievecompetencymethodradicalhysterectomybilateralsalpingo-oophorectomylymphnodedissectionrequiredreachtwostudysurgeryBackground:advantagesdisadvantagescomparedminimallyinvasiveapproachesdebatedObjective:MaterialsMethods:performedincludingEnglishlanguageobservationalinterventionalreportingabsolutealongobjectivereproducibleMainoutcomemeasures:NumberextractedResults:Sixtotal545womenSeveralassessedminimumsmallerfoursacrocolpopexyloweroneConclusion:curvereportedquickerHoweverstandardisedwidelyacceptedendoscopicwellrandomisedclinicaltrialsespeciallyinvolvinginexperiencedsurgeonsWhatnew?:mayfirstLCsComparisonrobot-assistedlaparoscopicgynaecology:

Similar Articles

Cited By