Emerging robotic platforms in gynecologic surgery: a systematic review.

Clinical Snapshot

Key Findings

• P Value: Not applicable — narrative systematic review without quantitative pooling

• Effect Size: No pooled effect size calculable; narrative synthesis reports generally favourable perioperative outcomes and acceptable short-term safety profiles across platforms

• Primary Outcome: Technical feasibility and short-term perioperative safety of 13 emerging robotic platforms across gynaecologic procedures (primarily hysterectomy and sacrocolpopexy)

• Nnt Or Sensitivity: Not calculable from available data; learning curve evidence strongest for da Vinci SP and HUGO RAS; cost data available primarily for Senhance and KANGDUO platforms only

• Confidence Interval: Not applicable — no meta-analysis performed

Clinical Application

Technical feasibility is demonstrated across platforms, but clinical adoption requires institutional investment in capital equipment, training infrastructure, and credentialing pathways. Learning curve data for most platforms beyond da Vinci SP and HUGO RAS remain insufficient to guide safe implementation timelines. In Australia, robotic gynaecologic surgery is performed predominantly with the da Vinci system (Intuitive Surgical), which holds TGA clearance. Emerging platforms such as Versius (CMR Surgical) have received TGA registration, while others (HUGO RAS, Senhance, hinotori, KANGDUO) have variable or absent TGA approval status as of the review period. The PBS does not currently provide specific rebates for robotic-assisted procedures beyond standard MBS item numbers for laparoscopic surgery, meaning cost-effectiveness data — currently limited to Senhance and KANGDUO in this review — are particularly relevant for Australian health technology assessment. RACGP and RANZCOG guidance on robotic surgery credentialing should be consulted before institutional adoption of any emerging platform. The review's findings support a cautious, evidence-gathering approach consistent with Australian Commission on Safety and Quality in Health Care (ACSQHC) principles for emerging surgical technologies. Female patients undergoing elective gynaecologic surgery at centres with access to emerging robotic platforms; most applicable to hysterectomy and sacrocolpopexy in selected patients at high-volume robotic surgery centres

Abstract

Robotic innovation in gynecologic surgery has expanded beyond established multiport ecosystems toward single-port, modular multi-arm, transvaginal, AI-enabled, and teleoperated platforms. However, available evidence remains fragmented and unsuitable for quantitative synthesis. This systematic review evaluated emerging robotic platforms in gynecologic surgery, focusing on procedure types, outcomes, costs, and learning curves. The review was prospectively registered in PROSPERO (CRD420261360389). Eligible studies included clinical studies evaluating emerging robotic platforms in gynecologic surgery. PubMed, Scopus, and Web of Science were searched on 4 April 2026. After duplicate removal, 408 records were screened, 160 full texts assessed, and 92 studies included. Data extraction and risk of bias assessment were performed independently in duplicate. The 92 studies covered 13 platforms and were mainly retrospective single-center studies. Evidence was most extensive for da Vinci SP and HUGO RAS, with more limited but informative data for Senhance, Versius, hinotori, and KANGDUO. Evidence for other systems consisted mainly of first-in-human, pilot, or feasibility studies. Hysterectomy and sacrocolpopexy were the most frequently reported procedures. Overall, perioperative outcomes and short-term safety appeared favorable, despite limited follow-up and heterogeneous outcome definitions. Cost data were mainly available for Senhance and KANGDUO. Learning-curve evidence was strongest for da Vinci SP and HUGO RAS. Risk-of-bias was predominantly moderate. Emerging robotic platforms have demonstrated broad technical feasibility and generally acceptable short-term perioperative safety in selected gynecologic procedures, but current evidence is heterogeneous, observational, and methodologically limited. Rigorous prospective studies, standardized economic analyses, longer follow-up, and learning-curve evaluations are needed before comparative conclusions can be drawn.

References

1. 1.Bruno, M., Arrigo, D., D'Indinosante, M., Perrone, E., Bizzarri, N., Panico, G., Macellari, N., Figà, M., Giménez, M., Forgione, A., Marescaux, J., Fagotti, A., & Fanfani, F. (2026). Emerging robotic platforms in gynecologic surgery: a systematic review. Journal of Robotic Surgery. https://doi.org/10.1007/s11701-025-03114-6