Minimally invasive approach for endometrial cancer: robotic assisted vs. straight stick laparoscopy

: The introduction of laparoscopic surgery in the early 1990’s presented an improved alternative to laparotomy, slowly shifting the surgical treatment for Endometrial Cancer (EC) toward minimally invasive surgery (MIS), with equivalent oncologic outcome and reduced perioperative morbidity. Robotic assisted surgery (RAS) introduced multiple technical improvements to straight stick laparoscopy (LS), associated with improved perioperative outcome including reduced blood loss, fewer conversions to laparotomy and shorter hospital stay, whereas other perioperative outcomes appear similar. Due to its technical advantages, adaptation of RAS involves a shorter learning curve than LS and offers improved ergonomics compared to straight stick instrumentation. The advantages of RAS are more pronounced in patients with increased body mass index (BMI). Both LS and RAS have been shown to be safe in elderly patients and although available data shows benefit compared to laparotomy, it does not suggest superiority of one MIS approach over the other. Even though RAS and LS have comparable oncologic outcomes, the integration of RAS facilitated the shift toward MIS, where LS had failed to significantly reduce the rate of laparotomy. This shift to MIS was associated with reduced postoperative length of stay and complication rates, offsetting the increased costs involved with RAS. By introducing a computer interface, RAS is allowing augmented reality and digital analysis, leading surgery towards precision surgery and a high-tech future.