“Comparison of robotic and laparoscopic myomectomy.”
Bedient, C. E., J. F. Magrina, et al. (2009).
Am J Obstet Gynecol.
OBJECTIVE: To compare surgical outcomes of patients with symptomatic leiomyomas after robot-assisted (“robotic”) or laparoscopic myomectomy. STUDY DESIGN: Retrospective chart review of 81 patients undergoing robotic (n = 40) or laparoscopic (n = 41) myomectomy. Data included fibroid characteristics (number, weight, location, and pathologic findings), operating time, blood loss, complications, and postoperative hospitalization length. RESULTS: Patients undergoing laparoscopy had a significantly larger mean uterine size, larger mean size of the largest fibroid, and greater number of fibroids. When adjusted for uterine size and fibroid size and number, no significant differences were noted between robotic vs laparoscopic groups for mean operating time (141 vs 166 minutes), mean blood loss (100 vs 250 mL), intraoperative or postoperative complications (2% vs 20% and 11% vs 17%, respectively), hospital stay more than 2 days (12% vs 23%), readmissions, or symptom resolution. CONCLUSION: Short-term surgical outcomes were similar after robotic and laparoscopic myomectomy; long-term outcomes were not assessed.
“Perioperative outcomes of robotically assisted hysterectomy for benign cases with complex pathology.”
Boggess, J. F., P. A. Gehrig, et al. (2009).
Obstet Gynecol 114(3): 585-593.
OBJECTIVE:: To report on the perioperative outcomes after robotically assisted total hysterectomy for benign indications in a large patient population with predominantly complex pathology. METHODS:: One hundred fifty-two patients underwent robotic hysterectomy for noncancer indications from May 2005 to May 2008. A systematic chart review of consecutive robotic cases was conducted based on preoperative and perioperative characteristics of each patient. Each case was evaluated for its complexity based on preoperative diagnosis, prior pelvic or abdominal surgery, patient’s body mass index, and uterine weight. RESULTS:: The overall operative time was 122.9 minutes, estimated blood loss was 79.0 mL, and there were three (2.1%) intraoperative complications, with no perioperative blood transfusions or conversions. There were five (3.5%) patients with postoperative complications, and length of hospital stay was 1.0 days on average. Of the characteristics indicating complexity, only uterine weight greater than 250 g resulted in significantly increased operative times, attributable to increased morcellation time. CONCLUSION:: Robotically assisted total hysterectomy for benign indications in patients with complex pathology is feasible, with low morbidity and a short hospital stay. This study suggests that robotic assistance facilitates the use of a minimally invasive approach in high-risk patient populations. LEVEL OF EVIDENCE:: III.
“Robotic gynecologic surgery: past, present, and future.”
Chen, C. C. and T. Falcone (2009).
Clin Obstet Gynecol 52(3): 335-343.
Robotic techniques are increasingly being used to perform gynecologic surgical procedures including hysterectomies, performed for benign and malignant indications, myomectomies, tubal reanastomoses, and sacrocolpopexies. Robotic procedures seem to confer the same benefits as laparoscopic surgery without additional complications. It is unclear, however, whether robotic surgery imparts any additional benefits such as decreased operative times when compared with open or conventional laparoscopic techniques. The advantages to robotic surgery include improved visualization of the operative field with increased dexterity allowing more precise movements. Disadvantages include the learning curve associated with learning a new surgical technique and the equipment and operating costs of the robot and of using the robot.
“Robotic adnexectomy compared with laparoscopy for adnexal mass.”
Magrina, J. F., M. Espada, et al. (2009).
Obstet Gynecol 114(3): 581-584.
OBJECTIVE:: To evaluate whether the application of robotic technology in the performance of adnexectomy resulted in benefits for the patient when compared with patients operated by laparoscopy. METHODS:: Evaluation of 85 patients undergoing robotic adnexectomy and comparison with a group of 91 patients operated on by laparoscopy during the same period of time and by the same surgeons. Patients were compared by age, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, indications, unilateral compared with bilateral adnexectomy, adhesions, size or weight or both of the adnexal mass, and previous abdominal or pelvic surgery. Univariate and multivariate analysis was used to determine factors favorable to each technique. Comparison between the groups was evaluated using the Fisher exact test from a one-way analysis of variance. RESULTS:: The robotic group had an increased number of obese (BMI 30 or more) and higher anesthetic risk (ASA classification 2 and 3) patients as compared with laparoscopy patients. The mean operating time was 12 minutes longer in the robotic group (P=.01). The mean blood loss (80 mL robotic, 71 mL laparoscopic), length of hospital stay (0.15 days robotic, 0.28 days laparoscopic), intraoperative complications (1% robotic, 2% laparoscopic), and postoperative complications (12% robotic, 11% laparoscopic) were similar in both groups. CONCLUSION:: Laparoscopy and robotics provided similar results for the performance of adnexectomy, with similar blood loss, intraoperative and postoperative complications, and length of hospital stay. Robotics mean operating time was 12 minutes longer. LEVEL OF EVIDENCE:: II.
“Surgical treatment of uterine myomas: Evolution of operative techniques.”
Nassif, J., C. Zacharopoulou, et al. (2009).
Traitement chirurgical des fibromes utérins: Évolution des techniques opératoires 11(2): 164-169.
Surgical treatment of uterine myomas have evoluted dramatically. While hysterectomy is associated to a low rate of recurrences, it is not always chosen by patients, also physicians are suggesting this modality in specific indications. Even in the absence of a desire to conceive, the will to keep the uterus makes one to prefer myomectomy. The latter has undergone substantial changes according to its indications, its surgical access, its surgical technique per se and the methods used to reduce bleeding intra operatively. Myomectomy can be done by laparotomy, mini laparotomy, laparoscopy, robotics, hysteroscopy or vaginal route. Hysterotomy facing the myoma can be vertical, horizontal or oblique. Use of Gonadotropin Realeasing Hormone agonist, vasopressin, ocitocine or mecanical means such as tourniquet around the lower uterine segment, uterine artery ligation or embolisation aim to facilitate surgical technique and keep a good vision in the operative field. Recent studies show that some of these adjuvants have higher efficacy than others. In this article, the evolution of surgical techniques and the recent evidence in the surgical treatment of uterine myomas are discussed.
“Is robotic surgery suitable for all gynecologic procedures?”
Zapardiel, I. (2009).
Acta Obstet Gynecol Scand: 1.
“Letter to the Editor regarding “A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy”.”
Hall, J. B. (2009).
“Robotic surgery in gynecologic oncology: impact on fellowship training.”
Hoekstra, A. V., J. M. Morgan, et al. (2009).
Gynecol Oncol 114(2): 168-172.
OBJECTIVES: To report the impact of a new robotic surgery program on the surgical training of gynecologic oncology fellows over a 12 month period of time. METHODS: A robotic surgery program was introduced into the gynecologic oncology fellowship program at Northwestern University Feinberg School of Medicine in June 2007. A database of patients undergoing surgical management of endometrial and cervical cancer between July 2007 and July 2008 was collected and analyzed. Changes in fellow surgical training were measured and analyzed. RESULTS: Fellow surgical training for endometrial and cervical cancer underwent a dramatic transition in 12 months. The proportion of patients undergoing minimally invasive surgery increased from 3.3% (4/110 patients) to 43.5% (47/108 patients). Fellow training transitioned from primarily an open approach (94.4%) to a minimally invasive approach (11% laparoscopic, 49% robotic, 40% open) for endometrial cancer stagings, and from an open approach (100%) to an open (50%) and robotic (50%) approach for radical hysterectomies. Fellow participation in robotic procedures increased from 45% in the first 3 months to 72% within 6 months, and 92% by 12 months. The role of the fellow in robotic cases transitioned from bedside assistant to console operator within 3 months. CONCLUSIONS: Fellow surgical training underwent a dramatic change with the introduction of a robotic surgery program. The management of endometrial and cervical cancer was impacted the most by robotics. Robotic surgery broadened fellowship surgical training, but balanced surgical training and standardized fellow training modules remain challenges for fellowship programs.
“Endometrial cancer in an adolescent: a possible manifestation of Cowden syndrome.”
Schmeler, K. M., M. S. Daniels, et al. (2009).
Obstet Gynecol 114(2 Pt 2): 477-479.
BACKGROUND: Cowden syndrome is an autosomal dominant disorder characterized by the development of multiple intestinal hamartomas, distinctive mucocutaneous lesions, and an increased risk of endometrial, breast, and thyroid cancer. CASE: An adolescent girl whose mother had a known germline PTEN mutation presented with abnormal vaginal bleeding and was diagnosed with a grade 2 endometrial adenocarcinoma. She underwent a robotic hysterectomy and was found to have no myometrial invasion or distant disease. Genetic testing revealed the patient to have the familial germline PTEN mutation. CONCLUSION: The strikingly young age of onset of this patient’s endometrial cancer highlights the need for additional study to better understand Cowden syndrome and to determine what endometrial cancer screening and preventive strategies are needed.
“What is the future for gynaecological surgery?”
Ellwood, D. (2009).
The Australian & New Zealand journal of obstetrics & gynaecology 49(2): 119.
“Letter to the Editor.”
Liu, C. S., D. Perisic, et al. (2009).
Journal of Minimally Invasive Gynecology 16(2): 243.
“Robot-assisted surgery in gynaecology.”
Oehler, M. K. (2009).
The Australian & New Zealand journal of obstetrics & gynaecology 49(2): 124-129.
Robotic surgery is the latest development in minimal invasive surgery. It provides superior visualisation and dexterity and therefore allows the surgeon to perform complex tasks that would exceed his/her abilities with conventional laparoscopy and would be associated with an increased morbidity if performed by laparotomy. Current evidence demonstrates the feasibility and safety of this technology in gynaecology. The costs of robotic surgery remain one of the main sources of controversy but are expected to come down with further developments of the technology. If evidence-based long-term outcome evaluations show the superiority of robotic surgery in comparison to conventional laparoscopic and open surgery, this technology will have a major impact on gynaecological surgery.
“The authors pioneered the use of the daVinci-system in gynaecologic oncology.”
Zweemer, R. P., H. W. R. Schreuder, et al. (2009).
Gynecological Surgery 6(3): 288-289.