Robot-assisted benign gynaecological surgery

Health Technology Wales
Record ID 32018013715
English
Authors' objectives: This report aims to identify and summarise evidence that addresses the following research question: What is the clinical and cost effectiveness of robot-assisted benign gynaecological surgery compared to standard care?
Authors' results and conclusions: Six systematic reviews of randomised controlled trials (RCTs) were identified, which compared robot-assisted hysterectomy, robot-assisted sacrocolpopexy and robot-assisted surgery for endometriosis to conventional laparoscopic surgery. Most of the RCT evidence investigated robot-assisted hysterectomy or robot-assisted sacrocolpopexy compared to conventional laparoscopic surgery. Two systematic reviews of large comparative observational studies reported outcomes for robot-assisted myomectomy compared to conventional laparoscopic myomectomy or open myomectomy, but no evidence compared it to vaginal myomectomy. Most of the outcomes were associated with no statistically significant difference between robot-assisted surgery and comparators. All systematic reviews reported that operating time was longer during robot-assisted surgeries than other surgical approaches. Experts suggested that this may be due to the learning curve of the system, the additional set-up time for robotic surgery and the fact that more complex surgeries may have been done with the robot. The RCT evidence included in this review indicates that women undergoing some types of robot-assisted benign gynaecological surgery have a shorter hospital stay, less blood loss, fewer complications and improved quality of life (QoL) than conventional laparoscopic surgery or open surgery. The observational evidence reported more statistically significant outcomes to support the effectiveness of robot-assisted benign gynaecological surgery than reported in RCTs. No RCT evidence was found for surgeon satisfaction. No relevant evidence was found for the subgroup analysis of pre- and post-menopause. We did not identify any evidence for use of robot-assisted surgery in people undergoing preventative surgery for increased familial risk of cancer. Most of the outcomes are reported by the authors of the systematic reviews as having very low- to low-certainty, mainly due to high risk of bias from lack of blinding. The observational outcomes were largely from retrospective studies and therefore associated with a high risk of bias. There was a high degree of heterogeneity observed for many of the pooled results, indicating that there is a high degree of inconsistency between the reported results of individual studies. HTW conducted a cost-consequence analysis to estimate the impact of introducing robotic-assisted surgery in benign gynaecological conditions. The analysis found that robotic-assisted surgery is likely to cost more than conventional laparoscopic hysterectomy, conventional laparoscopic sacrocolpopexy and open sacrocolpopexy. This finding was robust to sensitivity and scenario analyses, supporting the conclusion that robotic-assisted surgery is likely to be a cost-incurring method of surgery. The appropriate mechanism for patient engagement was determined and the patient perspective was considered where possible. The Fair Treatment for the Women of Wales (FTWW) provided detailed information on equity issues that robotic surgery has the potential to address for patients with female anatomy.
Authors' recommendations: Robotic-assisted surgery shows promise for benign gynaecological conditions, but the evidence is insufficient to support routine adoption. This appraisal included robot-assisted hysterectomy, myomectomy, sacrocolpopexy and surgery for endometriosis. Current evidence from randomised controlled trials demonstrates that robotic-assisted surgery has similar outcomes to other minimally invasive options, and a cost-consequence analysis undertaken by HTW showed higher costs across a range of modelled scenarios when using robotic-assisted surgery compared to laparoscopic hysterectomy, laparoscopic sacrocolpopexy, and open sacrocolpopexy. As expert opinion and patient perspective highlighted that there may be additional benefits to robotic-assisted surgery, further research is recommended to better understand the clinical effectiveness, safety, and cost effectiveness of robotic surgery in benign gynaecological conditions. In particular, research is encouraged following the learning curve for robotic surgery, as more benefits in terms of reduced operational time, length of stay and improved safety may be realised in this instance.
Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.
Authors' identified further research: Further research is recommended to better understand the clinical effectiveness, safety, and cost effectiveness of robotic surgery in benign gynaecological conditions. In particular, research is encouraged following the learning curve for robotic surgery, as more benefits in terms of reduced operational time, length of stay and improved safety may be realised in this instance.
Details
Project Status: Completed
Year Published: 2024
English language abstract: An English language summary is available
Publication Type: Rapid Review
Country: Wales, United Kingdom
MeSH Terms
  • Uterine Prolapse
  • Robotic Surgical Procedures
  • Robotics
  • Gynecologic Surgical Procedures
  • Hysterectomy
  • Uterine Myomectomy
  • Endometriosis
  • Cost-Effectiveness Analysis
Keywords
  • Hysterectomy
  • Myomectomy
  • Sacrocolpopexy
  • Endometriosis
  • Versius
  • da Vinci
  • Robot-assisted benign gynaecological surgery
  • Robotics
Contact
Organisation Name: Health Technology Wales
Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD
Contact Name: Susan Myles, PhD
Contact Email: healthtechnology@wales.nhs.uk
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.