Case study: HTW appraisal of robot assisted benign gynaecological surgery

What did we do?

HTW considered the use of robot-assisted benign gynaecological surgery. We appraised the clinical and economic evidence on this topic, published an Evidence Appraisal Report, and published HTW Guidance in October 2024.

 Who with?

This topic was proposed by colleagues in the NHS. We engaged with several different stakeholder groups during the development of this appraisal. During the consultation period, we received feedback from numerous gynaecology consultants from around the UK.

What did we learn?

Current evidence from randomised controlled trials demonstrates that robot-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 robot-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 robot-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.

What difference did it make?

The HTW Appraisal Panel concluded that although robot-assisted surgery shows promise for benign gynaecological conditions, the evidence is insufficient to support routine adoption. This appraisal included robot-assisted hysterectomy, myomectomy, sacrocolpopexy and surgery for endometriosis.