254 Journal of the College of Physicians and Surgeons Pakistan 2020, Vol. 30 (3): 254-258 INTRODUCTION Compared with laparotomy, the use of laparoscopic technology for gynecological procedures has resulted in significant patient benefits, including decreased blood loss, shorter hospital stays, faster recovery, improved cosmesis and decreased postoperative pain. 1,2 Approxi- mately 500,000 women undergo elective laparoscopic hysterectomy in the United States alone, with the majority (87%) being for benign uterine pathologies. 2 Laparoscopic gynecological procedures are indicated for several conditions. For example, intractable abnormal uterine bleeding (AUB) is an indication for laparoscopic hysterectomy. 3 Similarly, laparoscopic procedures are used for treating cases of uterine fibroids after failure of conservative therapy. 4 Laparoscopy has also revolu-tionised the treatment of ovarian cysts, another common indication for gynecological surgery. 3,4 The advantages of the laparoscopic approach include minimising tissue trauma and maintaining moistness in the tissues, thereby decreasing the possibility of adhesion formation. 5 Nevertheless, laparoscopic techniques have inherent drawbacks that result in their slow incorporation into the surgical practices of most gynecologists. 6 Limi- tations imposed by two-dimensional vision, instrument rigidity, and counterintuitive movements were among the reasons that have been proposed to slow the wide- spread adoption of laparoscopic techniques. 7 The steep learning curve for surgeons and longer operative times along with ergonomic difficulty and tremor amplification are major obstacles in the widespread acceptance and application of minimally invasive surgical techniques in gynecological surgery. 6,7 Numerous studies comparing standard laparoscopic gynecological surgery (S-LGS) and robot-assisted lyparo- scopic gynecological surgery (RA-LGS) have shown improved surgical accuracy, faster intracorporeal knot tying, reduced skill-based errors and shorter time required for learning. 5-8 However, there is a lack of data regarding RA surgeries from developing nations, where training is necessary to improve the frequency of use and outcomes of such technologies. Therefore, the primary aim of the present study was to compare the outcomes, particularly short-term ones, and the complications between these procedures in a tertiary care facility in Saudi Arabia. ORIGINAL ARTICLE Outcomes of Robot-assisted Laparoscopic Gynecological Surgery Munazzah Rafique, Tehmina Aziz and Sahar Al-Suwailem Women Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia ABSTRACT Objective: To compare the outcomes of robot-assisted (RA) and standard laparoscopic gynecological surgery (S-LGS) in a tertiary care hospital, and evaluate the factors affecting the outcomes of RA-LGS to identify areas of improvement. Study Design: A descriptive study. Place and Duration of Study: King Fahad Medical City, Riyadh, Saudi Arabia, from 2013 to 2018. Methodology: In this 5-year retrospective study, 65 LGS cases, including 37 RA-LGS and 28 S-LGS, in a single tertiary care hospital, were included. Demographic data, clinical pathological details, and complications of the cases were recorded. Surgeons performing RA-LGS were also interviewed regarding their training/experience, competency of surgical assistance, and suggestions for improving training. Results: Operative times (3.70 ±0.96 vs. 2.07 ±0.78 h, p <0.001) and hospital stays (3.53 ±3.29 vs. 1.96 ±1.34 days, p=0.022) were significantly longer in the RA-LGS group than in the S-LGS group. Intraoperative complications, which were primarily adjacent organ damage (21.6% vs. 0.0%, p=0.029), were significantly more common in the RA-LGS group. There were no significant differences between the groups in terms of the need to convert to laparotomy, immediate/late postoperative complications, estimated blood loss, or the need for blood transfusion. The interview survey results suggested the lack of a trained team assisting in RA-LGS, as the reason for the poor outcomes. Conclusion: There were no advantages of RA-LGS over S-LGS. Longer training periods for RA-LGS, with minimum 20-50 cases as part of a structured training programme, may improve outcomes. Key Words: Laparoscopic surgeries, Robot-assisted surgical procedures, Gynecological disease, Uterine cancer, Menorrhagia. How to cite this article: Rafique M, Aziz T, Al-Suwailem S. Outcomes of robot-assisted laparoscopic gynecological surgery. J Coll Physicians Surg Pak 2020; 30(3):254-258. Correspondence to: Dr. Munazzah Rafique, Women Specialized Hospital, King Fahad Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia E-mail: munazzahr@yahoo.com Received: June 25, 2019; Revised: January 30, 2020; Accepted: January 30, 2020