Facts, Views & Vision
in ObGyn

Journal of the European Society for Gynaecological Endoscopy

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

D. Raimondo1*, A. Raffone2,3, D. Neola4, L. de Landsheere5*, R.A. de Leeuw6,7*, L. Mereu8,9*, T. Badotti10, E. Pazzaglia1,2, R. Seracchioli1,2, G. Scambia11, F. Fanfani11*

1 Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
2 Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
3 Department of Woman, Child, and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
4 Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
5 Department of Obstetrics and Gynaecology, CHR de La Citadelle, University of Liège, 4000 Liège, Belgium
6 Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Department of Obstetrics & Gynaecology, De Boelelaan 1117, 1081 Amsterdam, the Netherlands
7 Amsterdam Reproduction and Development, 1081 Amsterdam, the Netherlands
8 CHIRMED Department of University of Catania, 95123 Catania, Italy
9 Department of Obstetrics and Gynaecology Policlinico G. Rodolico di Catania, 95123 Catania, Italy
10 Hospital e maternidade municipal de Sao José dos Pinhais, 83005-040 Sao José dos Pinhais, Brazil
11 Department of Woman, Children and Public Health Sciences, Gynaecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Institute of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, 00168 Rome, Italy.

* European Society for Gynaecological Endoscopy (ESGE) Special Interest Group (SIG) on Robotics.

Keywords:

Robotic laparoscopic surgery, gynaecologic surgery, proficiency, learning curve


Published online: Dec 18 2024

https://doi.org/10.52054/FVVO.16.4.047

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