The US Perspective of Benefit of Minimally Invasive Surgery: Why Is This Important Now?

With the advent of new technologies, surgical specialties have witnessed impressive changes in operative techniques, shifting toward minimally invasive procedures, including laparoscopic and robotic approaches. The benefits of minimally invasive surgery are abundant—improved postoperative pain control, decreased postoperative hospitalization, and less estimated blood loss, among others. Within the realm of gynecology, there has been widespread use of laparoscopic approaches for common procedures, including hysterectomy and myomectomy, and current evidence supports improved clinical outcomes for laparoscopic technique compared to conventional laparotomy for such procedures. Introduction of robotic platforms has further revolutionized the field of minimally invasive gynecologic surgery. Robotic hysterectomy has shown promise, with comparable clinical outcomes, decreased hospitalization, shift toward outpatient procedure, and improved postoperative pain profile compared with laparoscopic approach. Similar benefits are seen for robotic myomectomy, with a significant reduction in intraoperative blood loss and postoperative pain. Resection of endometriosis is a complex procedure that requires impeccable visualization and surgical dexterity, which are components of laparoscopy that require further refinement; robotic platforms have the ability to improve upon laparoscopy and aid in endometrial resection, particularly in complex cases. With most robotic gynecologic operations, operative times are cited to be longer than with laparoscopic approaches, which can be mitigated by increased surgeon experience. Cost remains a barrier to implementation of robotic surgical systems, with the largest contributor to overall cost being the initial acquisition of the platform; however, largest predictor of cost-effectiveness of robotics in gynecology remains physician expertise, supporting the continued commitment to minimally invasive technology.