Evaluation of surgical outcomes and costs during the learning curve in robotic gynecologic surgery: a systematic review and meta-analysis.
Serhat Sen, Feyza Gulgel Sen
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In 30 seconds
This systematic review and meta-analysis examined whether surgical outcomes and costs differed between earlier and later cases of the same robotic gynecologic procedures. Twenty-one reports were included; 19 contributed 25 time comparisons, covering 1,305 phase observations. In 13 primary reports with 923 observations, later procedures were associated with operative times 31 min shorter (95% CI 16-46; I²=65.3%; very low certainty), a 19.6% reduction. Evidence did not establish clear reductions in blood loss or hospital stay, and complication findings varied.
Key findings
- Across 13 primary reports (923 observations), later procedures were 31 min shorter (95% CI 16-46; I²=65.3%; very low certainty).
- Blood-loss (-6.3 mL) and hospital-stay (-0.08 days) differences remained uncertain.
- Three programs reported lower hospital costs: mean reductions of $2,222 and $4,457 and a median difference of $83 (2025 USD).
- Exploratory resource valuation estimated -$1,068 per case (95% CI -$3,747 to $1,610).
Why it matters
The findings suggest that operative time may improve as experience accumulates, while evidence for changes in other outcomes and costs is less conclusive. This distinction matters when interpreting efficiency gains: shorter procedures do not by themselves establish lower overall costs or improved patient outcomes, particularly when complication findings vary and the certainty of the time estimate is very low.
What to keep in mind
The evidence came from observational comparisons with heterogeneous definitions; complication findings could not be pooled. Certainty for the operative-time estimate was very low, and the review notes that surgeons’ time and personal financial investment require prospective evaluation.