The field of robot-assisted surgery has developed rapidly and its use for gynecologic conditions has grown exponentially since its 2005 approval by the FDA for gynecologic procedures 1 2. The document has been revised to exclude gynecologic malignancies.įor noncancerous conditions, such as hysterectomy, a minimally invasive approach to gynecologic surgery has well-documented advantages-including faster return to normal activities, decreased length of stay, and better quality of life-compared with an abdominal approach. This Committee Opinion is updated to reflect an expansion of the literature regarding the role of robot-assisted surgery in patients with endometriosis. Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience Database (MAUDE) to report adverse events. Further comparative studies are needed to assess long-term outcomes and patient safety, and to identify specific subgroups of patients who would benefit from a robot-assisted approach.Īs with any procedure, informed consent should be obtained from patients before surgery with discussion of the surgeon’s experience with robot-assisted surgery, indications for surgery, and potential risks and benefits associated with the robot-assisted technique compared with alternative surgical approaches and other therapeutic options.īoth ACOG and SGS recommend the development of a registry of robot-assisted gynecologic procedures and the use of the U.S. Robot-assisted surgery provides an alternative surgical tool for minimally invasive gynecologic surgery. Robot-assisted cases should be selected based on the likelihood of improved outcomes compared with other surgical approaches due to the complexity of the case or patient factors, with appropriate consideration to costs. Studies suggest that robot-assisted gynecologic surgery can be performed safely in centers with experienced surgeons and has perioperative outcomes equivalent to laparoscopy and improved outcomes compared with laparotomy. The American College of Obstetricians and Gynecologists (ACOG) and Society of Gynecologic Surgeons (SGS) make the following recommendations and conclusions: Well-designed studies are needed to determine which patients are most likely to benefit from robot-assisted surgery over other minimally invasive approaches. Ongoing quality assurance is essential to ensure appropriate use of the technology and, most importantly, patient safety. Obstetrician–gynecologists not previously trained in robot-assisted surgery can acquire the necessary skills through independent robot-assisted training programs and through courses offered and accredited by organizations such as the American College of Obstetricians and Gynecologists, the Society of Gynecologic Surgeons, the American Association of Gynecologic Laparoscopists, the Society of Gynecologic Oncology, and the American Urogynecologic Society. Although training in robot-assisted surgery increasingly is incorporated into obstetric and gynecologic residency programs, exposure to and training with robotic devices varies nationally. Adoption of new surgical techniques should be driven by what is best for the patient and by evidence-based medicine, rather than external pressures. Reporting of adverse events currently is voluntary and nonstandardized therefore, the true rate of complications is not known. Although the quality of data for robot-assisted surgery is still low to moderate, the use of robot-assisted surgery has rapidly increased since its approval, which highlights the need to develop effective and thoughtful strategies for its implementation. ABSTRACT: For noncancerous conditions, such as hysterectomy, a minimally invasive approach to gynecologic surgery has well-documented advantages-including faster return to normal activities, decreased length of stay, and better quality of life-compared with an abdominal approach.