Robot-assisted gynecologic surgery in elderly patients: perioperative outcomes and risk assessment in patients aged 70 years and older.

Abstract

Robot-assisted surgery has become widely accepted as a minimally invasive approach. However, its safety and feasibility in older women undergoing gynecologic procedures remain insufficiently explored. This retrospective study compared perioperative outcomes between two older age groups and evaluated surgical risks by using the E-PASS and POSSUM scoring systems. A total of 61 women aged ≥ 70 years who underwent robot-assisted gynecologic surgery at our institution were analyzed. Endometrial cancer cases involved hysterectomy with sentinel lymph node biopsy, while procedures for pelvic organ prolapse included sacrocolpopexy with vaginal surgery. The patients were categorized into pre-old (70-74 years) and old (75-89 years) groups. Although prior abdominal surgery was significantly more common in the old group (58.3 vs. 13.5%, p = 0.0003), no significant differences were found in comorbidities, the operative time (242 vs. 235 min), blood loss, or the duration of hospital stay. One pre-old patient developed a pelvic infection (Clavien-Dindo grade IIIa); no other serious complications occurred, and overall complication rates were similar. Two cases of postoperative delirium were not predicted preoperatively. Perioperative risk scores indicated a low risk in both groups. While midterm postoperative outcomes were generally favorable, some patients experienced new health-related events, which were unrelated to surgery. These findings suggest that robotic surgery is feasible and that age alone should not be a contraindication. However, importantly, these outcomes were achieved in a cohort that received comprehensive perioperative care; therefore, further studies with larger cohorts are needed. Moreover, perioperative planning should consider not only physical conditions but also the cognitive and mental status, the living environment, and social support.