Minimally Invasive Gynecologic Surgery and Enhanced Recovery and Outcomes: A Literature Review

Abstract

Enhanced recovery after surgery (ERAS) protocols have significantly improved clinical outcomes in patients undergoing minimally invasive gynecological procedures. However, the absence of protocol uniformity among institutions, uneven implementation, uneven compliance, and the absence of research randomization limit the generalizability of findings. The aim of the review is to evaluate technological advancement, the efficacy of the integration of ERAS in minimally invasive gynecological surgery (MIGS) to improve clinical outcomes, challenges and controversies, and the way forward. The implementation of ERAS within minimally invasive gynecologic procedures leads to considerable positive results in postoperative outcomes. The implementation of ERAS protocols produces reduced pain and lower opioid requirements along with earlier patient mobilization and decreased hospital stays and an enhanced potential for same-day discharge for various benign and malignant gynecological procedures performed through laparoscopic, robotic, or vaginal techniques. The effectiveness of ERAS pathways demonstrates consistency among different surgical patient groups, such as adolescent and elderly women and gynecologic oncology patients, thus proving its broad clinical efficiency for current surgical procedures. A major benefit of this review stems from multiple research methods and extensive sample sizes, and multiple clinical settings to improve the universal application of research findings. The evidence showed that ERAS implementation was cost-effective, which proves it provides clinical and economic benefits. The implementation of ERAS protocols faces continued challenges because of diverse elements such as inconsistent patient adherence, possible publication bias, and insufficient long-term measurements. The studies use differing standardized outcome measures, which creates barriers to making direct outcome comparisons between them. The existing body of evidence supports establishing ERAS as a standard practice because it contributes to improved recovery and enhances both patient experience and healthcare operational effectiveness during minimally invasive gynecologic procedures.

Keywords: clinical outcomes; enhanced recovery after surgery; enhanced recovery after surgery (eras); future directions; minimally invasive gynecologic surgery.