A systematic review and bibliometric analysis of robot vs. laparoscopic surgery in urogynecology: current trends and future directions

Abstract

We aim to evaluate the current role of robot-assisted surgery in urogynecology by comparing its outcomes and applications to those of laparoscopic surgery. We ran a computed search on PubMed, Cochrane Library, Scopus, Web of Science, and Ovid MEDLINE in January 2024. Our review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO (CRD42024500936). Our search strategy targeted commonly performed urogynecological surgeries, such as Burch colposuspension, fistula repair, urethropexy, pelvic organ prolapse (POP), sacrohysteropexy, sacrocolpopexy, cervicosacropexy, enterocele, cystocele, urinary incontinence, pectopexy, cervicopectopexy, colpopectopexy, native tissue repair, and anterior and posterior colporrhaphy. We included only original studies comparing robot-assisted and laparoscopic approaches in urogynecological surgeries. Additionally, we conducted a bibliometric analysis of the selected studies. Our final analysis included 36 studies, where 32 studies focused on POP, with sacrocolpopexy being the most frequently performed procedure (88.9%). Most of the studies originated from high-income countries. Most studies were retrospective (63.9%). The analysis included data on 29,172 patients, with 52.5% undergoing laparoscopy and 47.5% undergoing robot-assisted surgery. While no significant differences were observed in complications such as mesh erosion, the robot-assisted surgery group exhibited a higher incidence, where all of them were sacrocolpopexy cases. The follow-up duration ranged from one week to three years, with substantial variability in the reporting of surgical duration and complications. Although robot-assisted surgery might promise improvements in urogynecology, particularly in sacrocolpopexy, the comparison with laparoscopy is inconclusive in terms of patient outcomes and complications. Further standardization of reporting and long-term data are needed to refine these findings. The major limitation of our study was the high heterogeneity among the studies.