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Robotic versus laparoendoscopic single-site hysterectomy: a systematic review and meta-analysis

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Abstract

Single-site hysterectomy (SSH) laparoscopic or robotic presented distinct advantages with regards to postoperative cosmetic outcome, wound-related complications and morbidity. We aimed to evaluate the feasibility of robotic and laparoscopic SSH in patients with benign or early-stage malignant gynecological conditions and to compare the two approaches. A systematic search of four electronic databases for articles published up to September 2019 was performed. Studies reporting outcomes for women who underwent robotic or laparoscopic SSH were considered eligible. A total of 6 studies with 412 patients were included. Among them, 150 women had robotic SSH, whereas 262 had laparoscopic SSH. Neither total operative time nor total hysterectomy time were found different among the 2 groups (355 patients MD 17.47 min, 95% CI − 5.82 to 40.76, p = 0.14 and 285 patients MD 6.41 min, 95% CI − 10.24 to 23.06, p = 0.45, respectively). Robotic approach presented significantly lower blood loss and hospital stay compared to laparoscopic (287 patients MD − 10.84 ml 95% CI − 20.35 to − 1.32, p = 0.03, 328 patients MD − 0.32 days, 95% CI − 0.44 to − 0.19, p < 0.00001, respectively). No difference was found with regards to major or overall postoperative complications. The present meta-analysis supports the use of robotic SSH, since it was related to faster recovery and comparable operative times and complication rates compared to laparoscopic. Nonetheless, due to the limited number of the included studies and their retrospective nature, the aforementioned outcomes must be interpreted with caution and further larger volume studies are needed in the field.

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References

  1. Bouquet de Joliniere J, Librino A, Dubuisson JB, Khomsi F, Ben Ali N, Fadhlaoui A, Ayoubi JM, Feki A (2016) Robotic surgery in gynecology. Front Surgy 3:26. https://doi.org/10.3389/fsurg.2016.00026

    Article  Google Scholar 

  2. Sandberg EM, la Chapelle CF, van den Tweel MM, Schoones JW, Jansen FW (2017) Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 295(5):1089–1103. https://doi.org/10.1007/s00404-017-4323-y

    Article  PubMed  PubMed Central  Google Scholar 

  3. Song T, Cho J, Kim TJ, Kim IR, Hahm TS, Kim BG, Bae DS (2013) Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial. J Minimal Invasive Gynecol 20(4):460–467. https://doi.org/10.1016/j.jmig.2013.01.010

    Article  Google Scholar 

  4. Daniilidis A, Chatzistamatiou K, Assimakopoulos E (2017) Is there a role for single-port laparoscopy in the treatment of endometriosis? Minerva Ginecol 69(5):488–503. https://doi.org/10.23736/s0026-4784.17.04036-9

    Article  PubMed  Google Scholar 

  5. Boruta DM (2016) Laparoendoscopic single-site surgery in gynecologic oncology: an update. Gynecol Oncol 141(3):616–623. https://doi.org/10.1016/j.ygyno.2016.03.014

    Article  PubMed  Google Scholar 

  6. Fader AN, Escobar PF (2009) Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol 114(2):157–161. https://doi.org/10.1016/j.ygyno.2009.05.020

    Article  PubMed  Google Scholar 

  7. Sendag F, Akdemir A, Oztekin MK (2014) Robotic single-incision transumbilical total hysterectomy using a single-site robotic platform: initial report and technique. J Minimal Invasive Gynecol 21(1):147–151. https://doi.org/10.1016/j.jmig.2013.07.004

    Article  Google Scholar 

  8. Scheib SA, Fader AN (2015) Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol 212(2):179.e171–178. https://doi.org/10.1016/j.ajog.2014.07.057

    Article  Google Scholar 

  9. Moukarzel LA, Fader AN, Tanner EJ (2017) Feasibility of robotic-assisted laparoendoscopic single-site surgery in the gynecologic oncology setting. J Minimal Invasive Gynecol 24(2):258–263. https://doi.org/10.1016/j.jmig.2016.10.013

    Article  Google Scholar 

  10. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clin Res Ed) 339:b2700. https://doi.org/10.1136/bmj.b2700

    Article  Google Scholar 

  11. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  PubMed  Google Scholar 

  12. DerSimonian R, Kacker R (2007) Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trial 28(2):105–114. https://doi.org/10.1016/j.cct.2006.04.004

    Article  Google Scholar 

  13. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13

    Article  PubMed  PubMed Central  Google Scholar 

  14. El Hachem L, Andikyan V, Mathews S, Friedman K, Poeran J, Shieh K, Geoghegan M, Gretz HF 3rd (2016) Robotic single-site and conventional laparoscopic surgery in gynecology: clinical outcomes and cost analysis of a matched case-control study. J Minimal Invasive Gynecol 23(5):760–768. https://doi.org/10.1016/j.jmig.2016.03.005

    Article  Google Scholar 

  15. Paek J, Lee JD, Kong TW, Chang SJ, Ryu HS (2016) Robotic single-site versus laparo-endoscopic single-site surgery for adnexal tumours: a propensity score-matching analysis. MRCAS 12(4):694–700. https://doi.org/10.1002/rcs.1707

    Article  PubMed  Google Scholar 

  16. Moon HS, Shim JE, Lee SR, Jeong K (2018) The comparison of robotic single-site surgery to single-port laparoendoscopic surgery for the treatment of advanced-stage endometriosis. J Laparoendosc Adv Surg Technique Part A. https://doi.org/10.1089/lap.2018.0118

    Article  Google Scholar 

  17. Cela V, Marrucci E, Angioni S, Freschi L (2018) Robot-assisted laparoscopic single-site hysterectomy: our experience and multicentric comparison with single-port laparoscopy. Minerva Ginecol 70(5):621–628

    Article  PubMed  Google Scholar 

  18. Gungor M, Kahraman K, Dursun P, Ozbasli E, Genim C (2018) Single-port hysterectomy: robotic versus laparoscopic. J Robot Surg 12(1):87–92

    Article  PubMed  Google Scholar 

  19. Paek J, Lee J-D, Kong TW, Chang S-J, Ryu H-S (2016) Robotic single-site versus laparoendoscopic single-site hysterectomy: a propensity score matching study. Surg Endosc 30(3):1043–1050

    Article  PubMed  Google Scholar 

  20. Lopez S, Mulla ZD, Hernandez L, Garza DM, Payne TN, Farnam RW (2016) A comparison of outcomes between robotic-assisted, single-site laparoscopy versus laparoendoscopic single site for benign hysterectomy. J Minimal Invasive Gynecol 23(1):84–88

    Article  Google Scholar 

  21. Akdemir A, Yildirim N, Zeybek B, Karaman S, Sendag F (2015) Single incision trans-umbilical total hysterectomy: robotic or laparoscopic? Gynecol Obstet Invest 80(2):93–98

    Article  CAS  PubMed  Google Scholar 

  22. Fagotti A, Corrado G, Fanfani F, Mancini M, Paglia A, Vizzielli G, Sindico S, Scambia G, Vizza E (2013) Robotic single-site hysterectomy (RSS-H) vs. laparoendoscopic single-site hysterectomy (LESS-H) in early endometrial cancer: a double-institution case–control study. Gynecol Oncol 130 (1):219–223

  23. Albright BB, Witte T, Tofte AN, Chou J, Black JD, Desai VB, Erekson EA (2016) Robotic versus laparoscopic hysterectomy for benign disease: a systematic review and meta-analysis of randomized trials. J Minimal Invasive Gynecol 23(1):18–27. https://doi.org/10.1016/j.jmig.2015.08.003

    Article  Google Scholar 

  24. Park D, Lee D, Kim S, Lee S (2016) Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: a systematic review and meta-analysis. Eur J Surg Oncol (EJSO) 42(9):1303–1314

    Article  CAS  Google Scholar 

  25. Park DA, Yun JE, Kim SW, Lee SH (2017) Surgical and clinical safety and effectiveness of robot-assisted laparoscopic hysterectomy compared to conventional laparoscopy and laparotomy for cervical cancer: A systematic review and meta-analysis. Eur J Surg Oncol 43(6):994–1002. https://doi.org/10.1016/j.ejso.2016.07.017

    Article  CAS  PubMed  Google Scholar 

  26. Pelosi MA, Pelosi MA 3rd (1991) Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. New Jersey Med 88(10):721–726

    CAS  Google Scholar 

  27. Uppal S, Frumovitz M, Escobar P, Ramirez PT (2011) Laparoendoscopic single-site surgery in gynecology: review of literature and available technology. J Minimal Invasive Gynecol 18(1):12–23. https://doi.org/10.1016/j.jmig.2010.07.013

    Article  Google Scholar 

  28. Fader AN, Cohen S, Escobar PF, Gunderson C (2010) Laparoendoscopic single-site surgery in gynecology. Curr Opin Obstet Gynecol 22(4):331–338

    PubMed  Google Scholar 

  29. Kane S, Stepp KJ (2010) Laparo-endoscopic single-site surgery hysterectomy using robotic lightweight endoscope assistants. J Robot Surg 3(4):253–255. https://doi.org/10.1007/s11701-010-0170-6

    Article  PubMed  Google Scholar 

  30. Iavazzo C, Minis EE, Gkegkes ID (2018) Single-site port robotic-assisted hysterectomy: an update. J Robot Surg 12(2):201–213. https://doi.org/10.1007/s11701-018-0789-2

    Article  PubMed  Google Scholar 

  31. Akdemir A, Zeybek B, Ozgurel B, Oztekin MK, Sendag F (2015) Learning curve analysis of intracorporeal cuff suturing during robotic single-site total hysterectomy. J Minimal Invasive Gynecol 22(3):384–389. https://doi.org/10.1016/j.jmig.2014.06.006

    Article  Google Scholar 

  32. Jayakumaran J, Wiercinski K, Buffington C, Caceres A (2018) Robotic laparoendoscopic single-site benign gynecologic surgery: a single-center experience. J Robot Surg 12(3):447–454

    Article  CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece

    Anastasia Prodromidou, Eleftherios Spartalis, Gerasimos Tsourouflis, Dimitrios Dimitroulis & Nikolaos Nikiteas

  2. 1st Department of Obstetrics and Gynecology, “Alexandra” General Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Anastasia Prodromidou

  3. 2nd Department of Propaedeutic Surgery, Laiko General Hospital, University of Athens Medical School, Athens, Greece

    Eleftherios Spartalis, Gerasimos Tsourouflis, Dimitrios Dimitroulis & Nikolaos Nikiteas

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  1. Anastasia Prodromidou
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  2. Eleftherios Spartalis
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Correspondence to Anastasia Prodromidou.

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A. Prodromidou, E. Spartalis, G. Tsourouflis, D Dimitroulis and N. Nikiteas declare they have no conflict of interest.

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Prodromidou, A., Spartalis, E., Tsourouflis, G. et al. Robotic versus laparoendoscopic single-site hysterectomy: a systematic review and meta-analysis. J Robotic Surg 14, 679–686 (2020). https://doi.org/10.1007/s11701-020-01042-1

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  • DOI: https://doi.org/10.1007/s11701-020-01042-1

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