Advances and Challenges in Robotic-Assisted Gynecologic Surgery: A Comprehensive Review of Port Strategies, Surgical Platforms, and Learning Curves in Japan

Abstract

Background

Robotic-assisted surgery has significantly advanced gynecologic surgery by improving precision, ergonomics, and patient outcomes. This review highlights recent developments and ongoing challenges in robotic gynecologic procedures, with a focus on port placement strategies, evolving surgical platforms, and learning curves. Particular emphasis is placed on Japan's growing experience, including novel techniques and training initiatives.

Methods

We conducted a literature review of English-language publications (2020–2025) focusing on robotic gynecologic surgery, particularly in Japan. Topics included surgical platforms (da Vinci, Hugo, hinotori), port configurations, clinical outcomes, and training. Selected studies were synthesized to reflect current evidence and expert consensus.

Results

Advancements include innovative port strategies (e.g., diamond configuration) and expanded use of alternative robotic systems. New platforms like Hugo and hinotori show comparable outcomes to da Vinci, despite longer setup times during early adoption. Robotic surgery provides advantages in complex benign cases and gynecologic cancers, such as improved lymph node mapping and reduced morbidity. Surveys in Japan show strong support for robotics, though barriers like cost and uneven access remain. Learning curve data suggest surgical proficiency can be achieved after 10–30 cases. However, consensus on certification remains divided.

Conclusion

Robotic-assisted gynecologic surgery is advancing rapidly, supported by technical innovation and improved clinical outcomes. Japan plays a key role in refining techniques and evaluating new systems. Although training and cost challenges persist, continued investment in education and infrastructure is essential to broaden access and optimize patient care.