Robotic surgery for gynaecologic cancer: an overview.

After decades of reluctance to change surgical approaches, new technologies have created new perspectives for surgery. Initially, the laparoscopic approach was considered to be only one useful for relatively simple procedures as the design of the instruments and the limited access hampered free movements to perform complicated surgery. Robotic systems overcame this problem and boosted the use of minimally invasive techniques also for radical gynaecological surgery. Robot-assisted laparoscopy can now routinely be used for the surgical treatment of early or downstaged cervical carcinoma, endometrial carcinoma and staging of early ovarian carcinoma. Robot-assisted laparoscopy has proven to be feasible, although the benefits for the patient are less clear than those for the surgeon. The main advantage of robot-assisted laparoscopy over conventional laparoscopy is probably not that it is safer or better, but that it allows more types of radical surgery to be performed and that it prevents the surgeon from developing complaints and muscular conditions that interfere with the ability to perform surgery. New applications have emerged with the introduction of new devices to be used in conjunction with the robotic system as well as with totally new robotic systems. Training in these new tools should be more systematic and structured to allow their safe introduction and use.