In recent years, the field of gynaecological surgery has witnessed a significant shift towards minimally invasive techniques. While conventional laparoscopy (CL) has brought about considerable advantages in terms of shorter hospital stays and quicker recovery, it has certain limitations, particularly in complex pelvic procedures. The introduction of robotic-assisted laparoscopy (RAL) has addressed many of these limitations, offering superior dexterity, intuitive movements, 3D vision, improved ergonomics, autonomous camera control, and a shorter learning curve. RAL provides precise operation capabilities, filtering out tremors and enhancing depth perception. The improved ergonomics of RAL over CL are also noteworthy, leading to fewer work-related musculoskeletal symptoms (WMS).
Clinical trials and studies have demonstrated that RAL can be as effective as CL for benign and malignant gynaecological diseases. It has shown to improve surgical performance without increasing surgical time, blood loss, or complications. RAL also reduces the conversion rate to laparotomy. The early adoption challenges, such as cost, learning curve, and operative times, have been gradually overcome as surgical expertise has increased, robotics have been implemented in high-volume centers, and surgical teams have received better training.
Robotic surgery is particularly beneficial in complex gynaecological cases. It is well-established for benign gynaecological procedures like tubal reconstruction, myomectomy, and hysterectomy. RAL has been especially advantageous in cases involving obese patients and those with complex pathologies, where traditional laparoscopy might be contraindicated. Recent advances in RAL have eliminated some of the previous disadvantages, such as the need for de-docking during pelvic and upper abdominal procedures.
The role of RAL in endometriosis surgery is promising. The ability to perform excisions more easily and safely, especially in deep infiltrating endometriosis (DIE), offers potential benefits. The use of 3D vision and the ease of lesion identification make RAL a valuable tool in endometriosis management.
In urogynaecology, RAL has expanded from prolapse surgery to other procedures like colposuspension and the management of vesicovaginal fistulas. It offers superior precision, lower error rates, a shorter learning curve, and better ergonomics. Prospective studies have shown improved patient outcomes, including improved voiding symptoms, sexual function, and reduced adverse events.
In gynaecological cancer surgery, RAL is commonly employed for procedures related to endometrial, cervical, and ovarian cancers. Studies suggest that RAL offers improved outcomes in terms of reduced complications and better survival, especially in complex cases. The introduction of robotics has also decreased the number of open operations, leading to reduced complications and overall costs.
While RAL has several benefits, it comes with higher costs, which may decrease as surgical expertise and technology develop. A structured training program and appropriate case selection are essential to optimize RAL surgery. Future research should focus on patient perspectives and attitudes toward robotic surgery as the field continues to evolve.

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