Robot-assisted benign gynaecological surgery
Topic Status Incomplete
Robot assisted benign gynaecological surgery
Outcome of the appraisal
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.
Why was this topic appraised?
Robot-assisted surgery for non-cancerous (benign) gynaecological conditions widens the eligibility of a minimally invasive approach to some patients who would ordinarily require an open approach. Experts report that wait-times for laparoscopic surgery can be a few years in NHS Wales for benign gynaecological conditions. They highlight that robot-assisted benign gynaecological surgery is not routinely available in NHS Wales, despite being widely available across the UK.
This topic was suggested to HTW by colleagues in the NHS.
Plain language summary
‘Benign gynaecological conditions’ refers to conditions that primarily involve the female reproductive organs that are not cancerous. This can include such conditions as urinary incontinence, uterine and/or vaginal wall prolapse, endometriosis, ectopic pregnancy, pelvic inflammatory disease and others. Treatments will depend on the condition, however surgery may be required.
In robotic assisted surgery, the surgeon controls a robot to conduct the surgery using tiny instruments. Images of the relevant body parts are projected on a screen. A surgeon remotely controls the instruments via the robotic arm.
Health Technology Wales looked for evidence on robot-assisted benign gynaecological surgery. The report considered evidence for endometriosis, uterine fibroids, pelvic organ prolapse. It also includes hysterectomy.
Topic Exploration Report
TER466 09.2023
Evidence Appraisal Review
EAR060 10.2024
Guidance
GUI060 10.2024
Health Technology Wales Partners
