The expanding spectrum of robotic gynecologic surgery: A review

Minimally invasive surgical approaches in gynecology have evolved considerably in the last 30 years. The integration of robotic technology represents significant progression along the continuum of minimally invasive operative techniques in gynecology utilized to treat both benign and malignant conditions. Robotic systems have the potential to convert surgical procedures that we presently perform by laparotomy to laparoscopy and are currently utilized in the fields of reproductive endocrinology and fertility, gynecologic oncology and female pelvic medicine/reconstructive surgery. Robotic-assisted procedures may help overcome some of the cited limitations associated with standard laparoscopy, including longer operative times, counterintuitive and limited instrument maneuverability, and lack of formal training and/or a steep learning curve. However, a critical appraisal of robotic systems is essential due to technological limitations. These limitations include a system that is bulky and costly to maintain and does not give haptic feedback, uncertainty about the long-term outcomes following robotic surgery, and the need for a greater number of larger incisions when compared to standard laparoscopy.