Surgery Advances in Gynecologic Tumors: The Evolution and Outcomes of Robotic Surgery for Gynecologic Cancers in a Tertiary Center

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript provides detailed insight on how robotic surgery adoption has been, and consequent effecting in gynecologic oncology in the past 16 years. The abstract gives a brief overview of the main findings, objectives of the study, and its significance. The paper is well organized in such a manner that it discusses clear sections of the different dimensions of application of robotic surgery among different types of gynecologic cancers. It presents a large dataset of sixteen years that offer a very comprehensive view of the development and impact of robotic surgery on the domain of gynecologic oncology. The authors describe the comprehensive analysis of the perioperative outcomes, including patient-related factors, surgical complications, and long-term survival outcome, so as to provide important information regarding the effectiveness and safety in robotic surgery. In the current study, the analysis encompasses the surgical, anesthetic, and oncological perspectives that identify the team effort needed toward the optimal harnessing of robotic surgery. In addition, it assesses the implementation costs for robotic surgery and provides important information for medical centers considering an implementation plan for robotic surgery.

Otherwise, though detailed, the information in the paper has very specific sections that need to be trimmed down, especially in the introduction and discussion section. This would help to clarify and make the manuscript more readable; leave out unnecessary details and focus on the pertinent outcomes. Much of this information in the manuscript refers to data from other studies but does not actually cite these. Inclusion with reference to all the data mentioned will give more strength to credibility and clarity of the study, connecting with relevant scholarly works. Further development of this section includes elaboration on the details with discussions on recent research, possible challenges, and future potentials.

Moreover, the section "Future Perspective" discusses future development and prototypes in robotic surgery. No peer-reviewed material is mentioned. There is a need for citing recent articles/research that have the basis for the paper in order to make their point more strengthened in accuracy. In summary, substantial insight has been provided in this paper on the deployment and effect of robotic surgery in the realm of gynecologic oncology. The research, therefore, with the mentioned areas of improvement carefully addressed, will clearly, and more reliably be of greater significance.

Author Response

Reply to Reviewers

Dear Editor,

We would like to thank  the reviewers for their time and  the comments and suggestions to improve the manuscript. Please see below our detailed reply to the comments.

The manuscript provides detailed insight on how robotic surgery adoption has been, and consequent effecting in gynecologic oncology in the past 16 years. The abstract gives a brief overview of the main findings, objectives of the study, and its significance. The paper is well organized in such a manner that it discusses clear sections of the different dimensions of application of robotic surgery among different types of gynecologic cancers. It presents a large dataset of sixteen years that offer a very comprehensive view of the development and impact of robotic surgery on the domain of gynecologic oncology. The authors describe the comprehensive analysis of the perioperative outcomes, including patient-related factors, surgical complications, and long-term survival outcome, so as to provide important information regarding the effectiveness and safety in robotic surgery. In the current study, the analysis encompasses the surgical, anesthetic, and oncological perspectives that identify the team effort needed toward the optimal harnessing of robotic surgery. In addition, it assesses the implementation costs for robotic surgery and provides important information for medical centers considering an implementation plan for robotic surgery.

Otherwise, though detailed, the information in the paper has very specific sections that need to be trimmed down, especially in the introduction and discussion section.

This would help to clarify and make the manuscript more readable; leave out unnecessary details and focus on the pertinent outcomes. Much of this information in the manuscript refers to data from other studies but does not actually cite these. Inclusion with reference to all the data mentioned will give more strength to credibility and clarity of the study, connecting with relevant scholarly works. Further development of this section includes elaboration on the details with discussions on recent research, possible challenges, and future potentials.

Thank you, we have significantly trimmed down the manuscript, removing all non-essential information, leading to the removal of 426 words or 11% of the manuscript. All relevant references were clearly indicated and used as comparisons to our published work.

 Moreover, the section "Future Perspective" discusses future development and prototypes in robotic surgery. No peer-reviewed material is mentioned. There is a need for citing recent articles/research that have the basis for the paper in order to make their point more strengthened in accuracy.

We have added all the references we could localize. We agree that much still needs to be published on the subject

In summary, substantial insight has been provided in this paper on the deployment and effect of robotic surgery in the realm of gynecologic oncology. The research, therefore, with the mentioned areas of improvement carefully addressed, will clearly, and more reliably be of greater significance.

Thank you

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this paper entitled "Surgery Advances in Gynecologic tumors: The Role of Robotic Surgery".

This is presented as a Review Article however the paper actually presents a retrospective analysis of robotic experince in a single institution in 16-year period.

The topic is extremely interesting and the potential of such a long term experience and amount of data could be outstanding.

I strongly advise the Authors to reconsider it as Original Research.  At present, there is a mixture of original data from the center and review of the literature in the different sections of the manuscript, which  makes the reading challenging. 

Introduction:line 31-33 this sentence is unclear. How can you assess the outcomes of your patients if you do not compare different surgical procedures? line 42-44 this is a conclusion and should be removed from the introduction section.

Since this is a long term retrospective analysis of mutiple surgical outcomes for different gynecologic cancers, it will be nice to know more about how the Authors retrieved data, patients selection, inclusion and exclusion criteria, which statistical analysis they perfomed and so on. Since I have advised to consider it as original reasearch,  a method section would be much beneficial as well as main objective. Which is the target of the data presentation? surgical outcome? oncological outcomes? cost analysis? all of them?

Liteterature review performed by the Authors is good but should be put in a Discussion section and compared to their original data. 

I really look forward to read the paper again as Original Article. 

Author Response

Reply to Reviewers

Dear Editor,

We would like to thank  the reviewers for their time and  the comments and suggestions to improve the manuscript. Please see below our detailed reply to the comments.

Thank you for the opportunity to review this paper entitled "Surgery Advances in Gynecologic tumors: The Role of Robotic Surgery".This is presented as a Review Article however the paper actually presents a retrospective analysis of robotic experince in a single institution in 16-year period.

Thank you. We have modified the title to make it more accurate, so the goal and expectations are clear:  “Surgery Advances in Gynecologic tumors: The evolution and outcomes of robotic surgery for gynecologic cancers in a tertiary center.”

The topic is extremely interesting and the potential of such a long term experience and amount of data could be outstanding.I strongly advise the Authors to reconsider it as Original Research.  At present, there is a mixture of original data from the center and review of the literature in the different sections of the manuscript, which  makes the reading challenging. 

As the manuscript represents a synthesis of previously published data, unfortunately we cannot present it as an original research, but we did modify the focus and made it about the historical description of the development of the program with the associated outcome data.

 Introduction:line 31-33 this sentence is unclear. How can you assess the outcomes of your patients if you do not compare different surgical procedures? line 42-44 this is a conclusion and should be removed from the introduction section.

Thank you, both sentences were removed.

Since this is a long term retrospective analysis of mutiple surgical outcomes for different gynecologic cancers, it will be nice to know more about how the Authors retrieved data, patients selection, inclusion and exclusion criteria, which statistical analysis they perfomed and so on. Since I have advised to consider it as original reasearch,  a method section would be much beneficial as well as main objective. Which is the target of the data presentation? surgical outcome? oncological outcomes? cost analysis? all of them?

We understand the concerns of the reviewer, but the methods and the analysis process were published in detail in the original manuscripts.

Literature review performed by the Authors is good but should be put in a Discussion section and compared to their original data. 

The sections contain a short review of our published findings per subject and we then added a brief context of other published works. We understand and appreciate the suggestions, and so we have added in each section a comment introducing the other published works are “as a comparison” or “in this context” on lines 89, 127, 185, 217, and 262.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Accepted after revision

Reviewer 2 Report

Comments and Suggestions for Authors

I thank the Authors for their amendments. I have no further indications