Original Title: Efficacité et innocuité de la chirurgie robotique ‒ Hystérectomie totale en cas de cancer de l’endomètre, prostatectomie radicale en cas de cancer de la prostate et néphrectomie partielle en cas de cancer du rein

Authors' objectives: With a view to acquainting itself with the effectiveness safety and cost-effectiveness of robotic surgery, the Ministère de la Santé et des Services sociaux’s Surgical Services Division (which has been transferred to Santé Québec) mandated the Institut national d’excellence en santé et en services sociaux to analyze the evidence concerning the use of surgical robots to perform total hysterectomies for endometrial cancer, radical prostatectomies for prostate cancer, and partial nephrectomies for renal cancer.

Authors' results and conclusions: RESULTS: (#1 ROBOTIC SURGERY: AN APPROACH AT LEAST COMPARABLE TO LAPAROSCOPIC SURGERY AND OPEN SURGERY): Overall, it appears that robotic surgery is at least comparable to laparoscopic surgery and open surgery in terms of clinical and organizational effectiveness and safety for the three indications of interest. (#2 KEY POINTS ABOUT ROBOTIC TOTAL HYSTERECTOMY FOR ENDOMETRIAL CANCER): The comparable outcomes between robotic and laparoscopic total hysterectomy were bilateral lymph node detection, recurrence-free survival, length of hospital stay, the probability of hospital readmission for any reason, the probability of overall complications of any severity, and the estimated blood loss during the procedure. (#3 KEY POINTS ABOUT ROBOTIC RADICAL PROSTATECTOMY FOR PROSTATE CANCER): The outcomes compared between robotic and open radical prostatectomy were urinary continence recovery 12 months after surgery, biochemical recurrence-free survival, health-related quality of life, and the probability of positive surgical margins, of hospital readmission for any reason and of major complications. (#4 KEY POINTS ABOUT ROBOTIC PARTIAL NEPHRECTOMY FOR KIDNEY CANCER): The comparable outcomes between robotic partial nephrectomy and open surgery were warm ischemia time, the probability of positive surgical margins, the probability of trifecta, and the estimated blood loss. CONCLUSION: The analysis shows that robotic surgery is at least comparable to laparoscopic surgery and open surgery in terms of safety, clinical and organizational effectiveness for the three indications of interest. However, given the limitations associated with the data and methodology of the included studies, the results should be interpreted with caution.

Authors' methods: A structured literature search in six bibliographic databases was conducted, targeting systematic reviews with meta-analyses, randomized and non-randomized comparative studies, economic studies, clinical practice guides, guidelines, and health technology assessment reports. These publications had to contain data on the clinical and organizational effectiveness, health-related quality of life, safety and costeffectiveness of robotic surgery – more specifically, on systems where the surgeon is entirely responsible for execution – compared with laparoscopic surgery or open surgery. The structured literature search was conducted for each indication and covered the period from January 2015 to December 2023. Depending on the indication, one or two updates to the search were carried out in 2024 in four bibliographic databases. To find publications containing recommendations or systematic reviews not indexed in the bibliographic databases, the websites of health technology assessment agencies, professional medical associations and learned societies in the field were consulted, as were the Google and Google Scholar search engines.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Technologies/Chirurgie_robotique_Hysterect_prostatect_nephrect_EC_INESSS.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)