Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Journal of robotic surgery
Emerging robotic platforms in gynecologic surgery: a systematic review.
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.
23 June 2026
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Surgery for women with anterior compartment prolapse
BACKGROUND: Anterior compartment prolapse is the most common pelvic organ prolapse. Clinicians have utilised various surgical techniques to minimise the rate of recurrent pelvic organ prolapse (POP). OBJECTIVES: To determine the benefits and harms of surgery for anterior compartment prolapse. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register on 29 April 2024. This includes records indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov and WHO ICTRP. We also handsearched journals, conference proceedings and the reference lists of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared surgical operations in women with anterior compartment prolapse. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed their risk of bias and extracted their data. MAIN RESULTS: We included 41 RCTs evaluating 4531 women. The certainty of evidence ranged from very low to moderate due to risk of bias and imprecision. Anterior native tissue repair versus biological graft at 1 to 2 years There is likely little to no difference between these two methods in terms of awareness of prolapse (RR 1.20, 95% CI 0.80 to 1.81; 5 RCTs, 515 women; moderate certainty). Native tissue repair likely increases the risk of recurrent anterior compartment prolapse (RR 1.53, 95% CI 1.19 to 1.97; 8 RCTs, 707 women; moderate certainty); the result suggests that if 21% of women had recurrent prolapse after biological graft, 24% to 40% would have recurrence after native tissue repair. There may be little to no difference between native tissue repair and biological graft repair groups for repeat surgery for prolapse (RR 0.99, 95% CI 0.45 to 2.17; 6 RCTs, 524 women; low certainty). Surgery for stress urinary incontinence was not reported. There is likely little to no difference between groups in dyspareunia (RR 0.87, 95% CI 0.39 to 1.93; 2 RCTs, 151 women; moderate certainty). De novo dyspareunia was not reported. Anterior native tissue repair versus transvaginal anterior permanent mesh at 1 to 2 years Native anterior tissue repair likely results in more awareness of prolapse than anterior mesh repair (RR 1.77, 95% CI 1.37 to 2.27; 10 RCTs, 1203 women; moderate certainty); the result suggests that if 13% of women were aware of prolapse after mesh repair, 17% to 29% would be aware after native tissue repair. Native tissue repair may result in slightly increased recurrent anterior compartment prolapse (RR 3.21, 95% CI 2.27 to 4.55; 20 RCTs, 2483 women; low certainty). There was moderate heterogeneity (I2 = 73%). The result suggests that if 13% of women had recurrent prolapse after mesh repair, 29% to 58% would have recurrence after native tissue repair. Repeat surgery for prolapse is probably more likely after native tissue repair (RR 2.17, 95% CI 1.31 to 3.58; 14 RCTs, 1799 women; moderate certainty); the result suggests that if 2% of women required repeat surgery after mesh repair, 3% to 8% would do so after native tissue repair. There is likely little or no difference between groups in surgery for stress urinary incontinence (RR 1.32, 95% CI 0.73 to 2.40; 6 RCTs, 967 women; moderate certainty). There is likely little or no difference between groups for dyspareunia (RR 1.06, 0.59 to 1.90; 8 RCTs, 1096 women; moderate certainty). There is likely little or no difference between groups for de novo dyspareunia (RR 0.64, 95% CI 0.36 to 1.12; 11 RCTs, 797 women; moderate certainty); the result suggests that if 7% of women reported dyspareunia after mesh repair, 2% to 8% would do so after native tissue repair. Permanent anterior vaginal mesh versus abdominal sacrocolpopexy at 1 year There may be little to no difference between permanent anterior vaginal mesh and abdominal sacrocolpopexy groups in awareness of prolapse (RR 0.93, 95% CI 0.45 to 1.94; 3 RCTs, 441 women; low certainty). There was some heterogeneity (I2 = 37%). There is likely little or no difference between groups in recurrent anterior compartment prolapse (RR 0.95, 95% CI 0.46 to 1.97; 4 RCTs, 306 women; moderate certainty). There was some heterogeneity (I2 = 69%). The result suggests that if recurrent prolapse occurred in 26% of women after sacrocolpopexy, 12% to 51% would have recurrence after transvaginal mesh repair. There may be little or no difference between groups in repeat surgery for prolapse (RR 1.68, 95% CI 0.56 to 5.04; 3 RCTs, 455 women; low certainty). There may be little or no difference between groups in repeat surgery for mesh complications (RR 2.61, 95% CI 0.62 to 10.99; 2 RCTs, 373 women; low certainty); the result suggests that if 1% of women needed repeat surgery for mesh exposure after sacrocolpopexy, 0.5% to 12% would do so after transvaginal mesh repair. There may be little or no difference between groups in surgery for stress urinary incontinence (RR 0.78, 95% CI 0.20 to 3.12; 2 RCTs, 299 women; low certainty). There was some heterogeneity (I2 = 60%). Dyspareunia was not reported. De novo dyspareunia is probably more likely to be reported with permanent anterior vaginal mesh than after abdominal sacrocolpopexy (RR 2.15, 95% CI 1.17 to 3.98; 2 RCTs, 248 women; moderate certainty); the result suggests that if 10% of women reported dyspareunia after abdominal sacrocolpopexy, 12% to 40% would do so with permanent anterior vaginal mesh. AUTHORS' CONCLUSIONS: Recurrence is probably more likely after native tissue repair than with biological graft or absorbable synthetic mesh at one to two years. We found no data for surgery for stress urinary incontinence. Anterior native tissue repair likely increases awareness of prolapse, recurrence and surgery for prolapse compared with transvaginal anterior permanent mesh repair. It is likely that fewer women report dyspareunia after abdominal sacrocolpopexy than with permanent mesh repair. For other outcomes, there was little or no difference between the groups being compared. Many of the transvaginal permanent meshes evaluated have been removed from the market because of reported complications. Five studies tested mesh kits that are currently available. We suggest that clinicians and women use caution when utilising these products as their long-term safety and efficacy have not yet been established.
28 Apr 2026
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