REVIEW   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2022 December;181(12):986-91

DOI: 10.23736/S0393-3660.22.04959-2

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Robotic-assisted laparoscopy in reproductive surgery: what is new?

Maria LONGO ¹ ✉, Giorgia GAIA ², Margarita AFONINA ², Carlo ALBONI ¹, Antonio LA MARCA ^{1, 3}

¹ Department of Medical and Surgical Sciences for Children and Adults, Institute of Obstetrics and Gynecology, Polyclinic of Modena, University of Modena and Reggio Emilia, Modena, Italy; ² School of Medicine, Department of Obstetrics and Gynecology, San Paolo Hospital, University of Milan, Milan, Italy; ³ Eugin Clinic, Modena, Italy

In recent years, the development of assisted reproductive technology (ART) techniques has revolutionized the field of reproductive medicine. In parallel with this, the role of surgery in the treatment of infertile couples has acquired growing interest. Robotic surgery represents the fusion of the conventional open surgery and the minimally invasive laparoscopic surgery. Several authors have analyzed the role of robotic-assisted laparoscopy (RAL) in reproductive surgery focusing on the most fertility-sparing procedures. The aim of the present study was to review the up-to-date publications of the last five years conducted by a literature search in PubMed database. The RAL has shown its potential benefits when compared to laparotomy. Most of the available studies are retrospective, observational, and non-comparative with a heterogeneous patients’ samples and methodology. This, together with the lack of randomized controlled trials (RCTs), made impossible to support a potential superiority of the Da Vinci surgery above the laparoscopic approach. Despite this, robotic assistance in reproductive surgery showed decreased blood loss, less postoperative pain, shorter hospital stays, and faster convalescence. Reproductive outcomes were comparable to open/laparoscopic approaches. The main disadvantages of robotic surgery were the major costs and operating times. The RAL is an innovative, safe, and qualified technique and represent a valid approach in the field of female reproductive surgery. The improved visualization and the assisted movements of robotic assistance allow to perform the more challenging steps with greater ease than laparoscopy. These aspects overcome the limitations of laparoscopy. Since low-quality evidence is available about the RAL superiority in the context of fertility surgery, randomized control trials performed in the setting of a well-implemented robotics program may further clarify the utility of the robotic approach in the field of fertility-sparing surgery.

KEY WORDS: Reproduction; Surgical procedures, operative; Laparoscopy; Endometriosis; Uterine myomectomy; Sterilization reversal