Meneses Alves Tiago, Ferreira De Castro Luís, Tomé António, Ferreira Hélder
Department of Gynecology and Obstetrics, Centro Materno Infantil do Norte-Unidade Local de Saúde de Santo António (CMIN-ULSSA), Porto, Portugal.
Instituto Ciências Biomédicas Abel Salazar-ICBAS, University of Porto, Porto, Portugal.
Arch Gynecol Obstet. 2025 May 27. doi: 10.1007/s00404-025-08055-x.
This study aims to evaluate and summarize the existing literature regarding the safety, efficacy, and outcomes of various energy sources in minimally invasive gynecological surgeries.
A systematic review was conducted by searching the PubMed/MEDLINE, Cochrane Library, and Web of Science databases. We included studies that compared different energy sources used in laparoscopic and robotic gynecological surgeries, focusing on their advantages and complications. 37 studies were ultimately included in this review.
Among the 37 studies, 24 were randomized controlled trials, 11 were retrospective studies, and 1 was prospective. In laparoscopic procedures, advanced energy sources were associated with reduced intraoperative blood loss and shorter operative times. Specifically, ultrasonic devices demonstrated significantly less thermal damage and facilitated easier postoperative histologic assessment of lymph nodes compared to conventional electrosurgery. In robotic assisted surgeries, the literature reported shorter hospital stays and reduced thermal injury during colpotomy when utilizing laser energy. No significant differences were observed in other perioperative outcomes across both minimally invasive approaches.
Advanced energy devices may offer advantages in gynecological minimally invasive surgery, particularly in minimizing tissue trauma and enhancing surgical precision. However, evidence on outcomes such as lateral thermal spread and tissue healing remains limited and inconsistent. Further high-quality comparative studies are needed to clarify the clinical implications of each energy source and guide optimal instrument selection, especially in robotic assisted procedures.
本研究旨在评估和总结关于各种能量源在微创妇科手术中的安全性、有效性及结果的现有文献。
通过检索PubMed/MEDLINE、Cochrane图书馆和科学网数据库进行系统评价。我们纳入了比较腹腔镜和机器人妇科手术中使用的不同能量源的研究，重点关注其优势和并发症。本评价最终纳入37项研究。
在这37项研究中，24项为随机对照试验，11项为回顾性研究，1项为前瞻性研究。在腹腔镜手术中，先进的能量源与术中失血减少和手术时间缩短相关。具体而言，与传统电外科手术相比，超声设备显示出明显更少的热损伤，并且便于术后更容易地对淋巴结进行组织学评估。在机器人辅助手术中，文献报道使用激光能量时，阴道切开术期间住院时间缩短且热损伤减少。在两种微创方法的其他围手术期结果方面未观察到显著差异。
先进的能量设备在妇科微创手术中可能具有优势，特别是在最小化组织创伤和提高手术精度方面。然而，关于侧向热扩散和组织愈合等结果的证据仍然有限且不一致。需要进一步的高质量比较研究来阐明每种能量源的临床意义并指导最佳器械选择，尤其是在机器人辅助手术中。
