Comparative analysis of robot-assisted and laparoscopic operations in oncogynecology

Aim. To determine the advantages and disadvantages of laparoscopic (LS) and robot-assisted (RA) surgery in oncogynecological operations.
Materials and methods. 282 clinical cases were retrospectively analyzed. The patients were treated in oncogynecological department No. 70 of the CS.P. Botkin City Clinical Hospital, Moscow Healthcare Department for endometrial cancer of stages IA–II, cervical cancer in situ and IA1 stages or atypical endometrial hyperplasia in the period from February 2020 to September 2022, among them 74 patients were operated with Da Vinci robotic units (models Si and Xi) and 208 using laparoscopy. The standard volumes of surgical treatment, depending on the clinical diagnosis, were: hysterectomy, hysterectomy with pelvic lymphadenectomy, hysterectomy with pelvic and retroperitoneal lumbar lymphadenectomy. To compare the technical characteristics of minimally invasive operations and the condition of patients in the intra- and postoperative periods in each group, data on the duration of operations, body mass index, age, intra- and postoperative complications, as well as the number of postoperative hospital bed-days were analyzed.
Results. When comparing the average duration of operations by time, a statistically significant difference was obtained. Thus, LS hysterectomy was performed 43 minutes faster on average than RA (74.2 minutes versus 117 minutes) (p <0.001). When performing pelvic lymphadenectomy, the average duration of RA operations was 28 minutes longer than LS operations (142 minutes versus 170 minutes), and when adding the retroperitoneal lymphadenectomy stage, the average duration of RA operations was 128 minutes longer than LS operations.
Conclusion. At this stage of technology development in surgery, LS operations have a number of advantages over RA ones in numerous ways. LS operations demonstrate statistically significantly shorter execution time, fewer perioperative complications, as well as a more controlled environment in the operating field. In the long term, RA surgery has serious potential and is currently at an early stage of its development. A real and sober assessment of its characteristics will determine the right direction for the development of this technology in the future.

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