Introduction/Background Several scientific publications that compare robotic and conventional laparoscopy surgery reveal some advantages for the patient of robotic surgery in certain gynecological procedures and pathologies. However, some authors consider the use of the surgical robot inefficient. Our aim is to evaluate whether robotic surgery could be a real benefit in terms of perioperative outcomes and morbidity without affecting oncological safety.

Methodology Data from 534 patients were collected, 347 of them were operated by robotic surgery (RS) and 187 by conventional laparoscopic approach (CL). A comparative study between both approaches was performed in a tertiary hospital from 2007 to 2019. Patients with endometrial, ovarian and cervical carcinoma were included.Basic demographic characteristic, surgical outcomes, morbidity and survival were compared. Procedures performed were hysterectomy with double adnexectomy, hysterectomy with lymphadenectomy (pelvic or pelvic and para-aortic), radical hysterectomy and para-aortic lymphadenectomy.

Results Total operation time was significatively longer in patient operated by robotic surgery (RS 209 minutes vs. 191 min CL; p=0.006). Blood loss was reduced in patients operated by robotic approach (RS 112 ml vs. CL 136 ml; p=0.020). No differences were found in hospital stay, number of pelvic or paraaortic nodes, laparotomic conversion or reintervention rate and intra or postoperative complications between both surgical approaches.Overall survival was similar in both surgical approaches although disease free survival was 85% in the robotic group and 90.7% in the laparoscopic group (HR: 0.47; IC95%:0.26–0.86; p=0.015). In a multivariant analysis the only independent factor related to disease free survival was FIGO stage.

Conclusion Robotic surgery and conventional laparoscopy are comparable in terms of perioperative morbidity, conversion rate, hospital stay, number of nodes obtained, or overall survival. Robotic surgery increases total operative time and reduces intraoperative bleeding compared to laparoscopy.