Robot-assisted surgery--point of no return?]

Robot-assisted laparoscopic surgery is a rapidly evolving technology, becoming widely applied as an alternative to open or laparoscopic gynecologic surgeries. The penetration of robot-assisted laparoscopic surgery into gynecologic surgeries in the past 6 years has been remarkable. The greatest advantages of this surgical technique are smaller incisions, leading to lower morbidity, less postoperative pain and shorter hospital stays. These techniques have been applied successfully in a wide variety of clinical fields including urology, cardiology, orthopedics, ophthalmology, neurosurgery and gynecology and have become important treatments of choice for patients. Although robot-assisted laparoscopic surgery is performed worldwide, only limited evidence of its superiority over traditional laparoscopic surgery exists. With the intent of reducing the invasiveness of traditional laparotomy (open surgery) and improving functional results, both in terms of decreased postoperative morbidity and faster postoperative recovery, surgical techniques evolve to become minimally invasive, first laparoscopic hysterectomy and then robot-assisted laparoscopic hysterectomy techniques. In Israel, approximately 45,000 gynecological surgeries are performed every year, and about tenth of these are hysterectomies. In this issue, Mejia-Gomez et al. describe the results of the first experience with robot-assisted Laparoscopic hysterectomy in Israel in 14 women in Hadassah Ein Kerem Hospital. Whilst debate continues about the evidence-based superiority of robot-assisted Laparoscopic hysterectomy, it appears that where robot-assisted systems exist, most patients will opt for the robotic-assisted approach and gynecologists will step forward to fill this niche because of its minimally invasive characteristics and clinical benefits, despite the lack of level I evidence.