Abstrakt Gynekologie Březen 2011

“Sun beams on hysterectomies.”

Mettler, L., W. Sammur, et al. (2011).

Gynecological Surgery: 1-13.


Are hysterectomies still necessary in 2010 and why and how should they be performed? As every now and then a critical evaluation of routine surgical procedure is necessary, there it is: This review follows the “Perspectives on laparoscopic hysterectomy” by Michelle Nisolle (Gynecol Surg 7:105-107, 2010). Hysterectomies performed in the field of obstetrics and gynaecology until the nineteenth century had always a lethal end. In the twentieth century, they were perhaps too frequently performed whereas the twenty-first century has witnessed a steep decline in hysterectomy numbers. It is therefore an opportune time to review the indications for hysterectomies, hysterectomy techniques and the present and future status of this surgical procedure. There is a widespread consensus that hysterectomies are primarily to be performed in cancer cases and obstetrical chaos situations even though minimal invasive surgical technologies have made the procedure more patient-friendly than the classical abdominal opening. Today, minimally invasive hysterectomies are performed as frequently as vaginal hysterectomies, and the vaginal approach is still the first choice if the correct indications are given. It is no longer necessary to open the abdomen; this procedure has been replaced by laparoscopic surgery with multiple and single port entries. Laparoscopic and robotic-assisted laparoscopic surgery can also be indicated for hysterectomies in selected patients with gynaecological cancers. For women of reproductive age, laparoscopic myomectomies and numerous other uterine-preserving techniques are applied in a first treatment step of menometrorrhagia, uterine adenomyosis and submucous myoma. These interventions are only followed by a hysterectomy if the pathology prevails. © 2011 Springer-Verlag.




“Effect of Body Mass Index on Robotic-Assisted Total Laparoscopic Hysterectomy.”

Nawfal, A. K., M. Orady, et al. (2011).

Journal of Minimally Invasive Gynecology.


STUDY OBJECTIVE: To estimate the impact of body mass index (BMI) on the surgical outcomes of patients undergoing robotic-assisted total laparoscopic hysterectomy. DESIGN: Retrospective cohort study. SETTING: Henry Ford Health System academic medical center (Henry Ford and Henry Ford West Bloomfield Hospitals) PATIENTS: A total of 135 patients who underwent scheduled robotic-assisted total laparoscopic hysterectomy for benign indications, without concomitant urogynecologic procedures between January 2008 and June 2010. INTERVENTIONS: Patients underwent robotic-assisted total laparoscopic hysterectomy as the intention to treat. Two cases were converted to laparotomy. MEASUREMENTS & MAIN RESULTS: Electronic medical records of all patients that underwent robotic-assisted total laparoscopic hysterectomy at Henry Ford Health System were reviewed. Data on demographics, BMI (kg/m(2)), estimated blood loss, perioperative hemoglobin change, procedure duration, hospital length of stay, specimen weight, pathology, and postoperative complications were obtained. The women’s median age was 45 years (range 30-68), 61.5% were black, and BMI ranged from 14.8-56.2 kg/m2; 23.4% of women were normal weight or less (BMI <25, n = 31), 52.7% of women were obese (BMI >30, n = 70) and 36 of these patients (27.1%) were morbidly obese (BMI >/=35). BMI did not correlate with procedure duration (Spearman r = .12, p = .16), length of stay (Spearman r = .10, p = .24), or estimated blood loss (Spearman r = .12, p =.18). Our analysis did not identify any meaningful associations between BMI and absolute change in hemoglobin. In addition BMI was not associated with an increase in major or minor complications. CONCLUSION: BMI is not associated with blood loss, duration of surgery, length of stay, or complication rates in patients undergoing robotic-assisted total laparoscopic hysterectomy. Robotic assistance may help surgeons overcome adverse outcomes sometimes found in obese patients.




“Da Vinci robotic-assisted radical hysterectomy procedural guide.”

Boardman, C., A. Huggins, et al. (2011).

Journal of Robotic Surgery: 1-7.


The Da Vinci robotic surgical platform has rapidly been adopted by skilled surgeons for procedures in gynecologic oncology. The lack of specific procedural guides and surgical atlases for robotic surgery in gynecologic oncology produces challenges in the education of trainees in their role both as the assistant and as the console surgeon. This procedural guide was developed in order to facilitate trainee education in the technical aspects of radical hysterectomy for cervical cancer using the Da Vinci robotic surgical platform. Patient selection, preparation, and the technical aspects of robotic radical hysterectomy are described from both the standpoint of the console surgeon and the bedside assistant. © 2011 Springer-Verlag London Ltd.




“Minimally Invasive Staging of Endometrial Cancer Is Feasible and Safe in Elderly Women.”

Frey, M. K., S. B. Ihnow, et al. (2011).

Journal of Minimally Invasive Gynecology 18(2): 200-204.


Study Objective: To compare the surgical outcome of elderly and younger patients undergoing laparoscopic or robotic surgical staging of endometrial cancer. Design: Retrospective analysis (Canadian Task Force classification II-2). Setting: University-affiliated hospital. Patients: One hundred twenty-nine patients comprised the study group. Sixty patients were aged 65 years or older (elderly group), and 69 patients were younger than 65 years (younger group). Intervention: Abdominal, laparoscopic, or robotic hysterectomy. Measurements and Main Results: Among the 109 patients who underwent laparoscopic or robotic staging, there were no differences in estimated blood loss, lymph node count, surgical time, complications, rate of blood transfusion, conversion to laparotomy, and mean postoperative stay between elderly and younger patients. Conclusion: Minimally invasive surgical staging for endometrial cancer is both feasible and safe in the elderly population and offers similar outcomes as in younger patients. © 2011 AAGL.




“Robotic-assisted resection of liver and diaphragm recurrent ovarian carcinoma: Description of technique.”

Holloway, R. W., L. A. Brudie, et al. (2011).

Gynecologic Oncology 120(3): 419-422.


Goals: To describe port placement and operative technique for resection of right hepatic and full-thickness diaphragm metastatic ovarian carcinoma in a patient with recurrent disease using the da Vinci® Surgical System. Case: A 60-year-old female with recurrent platinum sensitive ovarian cancer presented with disease confined to the liver by PET-CT scan. The lesion measured 3.4 cm on the dome of the right hepatic lobe. After two attempts at intra-hepatic arterial chemo-embolization the lesion remained stable. She subsequently agreed to robotic-assisted resection of the right lobe liver mass after refusing laparotomy for 9 months. Procedure: Pnuemoperitoneum was established in the left upper quadrant by directly inserting a 5-mm laparoscope. There were no midline adhesions. The 12-mm camera port was placed in the midclavicular line on the right 10 cm off the costal margin with the right and left operative arms 10 cm from the camera near the costal margin, and the third arm in the right flank. The robot was docked from the right shoulder. Resection was accomplished with a monopolar spatula in the right, fenestrated bipolar grasper in the left, and double fenestrated grasper in the third operative arm. Adhesions between diaphragm and liver were separated, the liver lesion was excised, the diaphragm lesion was resected full thickness, and diaphragm was closed with running prolene. Surgicel® was placed on the liver for hemostasis. Console time was 82 min and the patient discharged on day-5 after drainage of a cytology negative pleural effusion day-4. Conclusions: Robotic resection of liver and full-thickness diaphragm lesions is possible. The port placement used in this patient was efficient and without operative arm collisions. Patients with isolated upper-abdominal recurrence are candidates for robotic secondary cytoreduction. © 2010 Elsevier Inc. All rights reserved.




“Robot-assisted versus total laparoscopic radical hysterectomy in early cervical cancer, a review.”

Kruijdenberg, C. B. M., L. C. G. Van Den Einden, et al. (2011).

Gynecologic Oncology 120(3): 334-339.


Objective: The aim of this study was to review current literature on total laparoscopic (TLRH) and robot-assisted radical hysterectomy (RRH) with pelvic lymphadenectomy in the treatment of early stage cervical cancer by analyzing data published in individual case series in order to compare surgical and oncological outcomes. Methods: Up to January 2010, 27 studies were identified that met the inclusion criteria, together with our own unpublished data of patients, accounted for 342 RRH patients and 914 TLRH patients. Results: There was no statistical difference between the methods in terms of age, BMI or prior abdominal surgery. Estimated mean operative time, blood loss and number of lymph nodes retrieved did not statistically differ between the RRH and TLRH method. Less blood transfusions were needed in patients treated by RRH (5.4%) versus TLRH (9.7%, p < 0.05). Both methods were similar in respect to adjuvant chemo- or (chemo)radiation and recurrence rate. When complications were prioritized to severity, major post-operative complications where more frequent in RRH patients (9.6%) than in TLRH patients (5.5%, p < 0.05). The length of hospital stay was significantly shorter in RRH compared to TLRH treatment (3.3 versus 6.2 days respectively; p:0.04). Conclusions: Robot-assisted and total laparoscopic radical hysterectomy appears to be equally adequate and feasible. RRH studies had small patient populations and further experience beyond the learning curve phase may improve operative time and complication rate. Both minimal invasive techniques should be investigated in a randomized manner. © 2010 Elsevier Inc. All rights reserved.




“Robotic surgery in gynecologic oncology.”

Lèguevaque, P., S. Motton, et al. (2011).

Gynecological Surgery: 1-9.


The goal of this paper is to review the current data documenting the advantages of robotic surgery over open or laparoscopic surgery. The aim of this study is to compare the complications and perioperative outcome of robotic surgery with open and laparocopic surgery, in gynecologic oncology. The terms radical robotic or robot- assisted hysterectomy in PubMed search lead to 41 references. We excluded one review of literature, ten studies with benign and malignant cases, eight cases reports, one letter to the editor. We kept the prospective studies and comparative studies (total abdominal hysterectomy (TAH) vs. total robotic hysterectomy (TRH), total laparoscopic hysterectomy (TLH) vs. TRH or TAH vs. TRH vs. TLH). The results are separated for endometrial cancers, early cervical cancers, pelvic and paraaortic lymph node dissections, radical parametrectomy and trachelectomy, and pelvic exenteration. The literature on robotic-assisted radical hysterectomy supports its safety and feasibility for the surgical management of early cervical cancer and endometrial cancer. However, the results of a phase III randomized clinical trial testing the equivalence of outcomes after laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy are expected. © 2011 Springer-Verlag.




“A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: A case-matched controlled study of the first one hundred twenty two patients.”

Lim, P. C., E. Kang, et al. (2011).

Gynecologic Oncology 120(3): 413-418.


Goal: To determine the learning curve and surgical outcome for the first one hundred twenty-two robotic hysterectomy with lymphadenectomy patients in comparison to the first one hundred twenty-two patients who underwent the same procedure laparoscopically. Materials and methods: An analysis of the first 122 patients who underwent a robotic assisted hysterectomy with lymphadenectomy (RHBPPALND) was compared to the first 122 patients who underwent a total laparoscopic hysterectomy with lymphadenectomy (LHBPPALND). The learning curve of the surgical procedure was determined by measuring operative time with respect to chronological order of each patient who had undergone their respective procedure. Number of lymph nodes, estimated blood loss, days of hospitalization, and complications of all patients were also analyzed and compared. Results: The learning curve of the surgical procedure was determined by measuring operative time with respect to chronological order of each patient who had undergone their respective procedure. Data were analyzed for mean age, body mass index, operative time, estimated blood loss, lymph node retrieval and complications for both surgical procedures. The mean operative time was 147.2 ± 48.2 and 186.8 ± 59.8 for RHBPPALND and LHBPPALND respectively. The mean EBL was statistically significant at 81.1 ± 45.9 and 207.4 ± 109.4 for RHBPPALND and LHBPPALND respectively. The total number of pelvic and aortic lymph nodes was 25.1 ± 12.7 for RHBPPALND and 43.1 ± 17.8 for LHBPPALND. The number of pelvic lymph node was 19.2 ± 9.0 and 24.7 ± 11.9 for RHBPPALND and LHBPPALND. The days of hospitalization of RHBPPALND and LHBPPALND were 1.5 ± 0.9 and 3.2 ± 2.3. The number of intraoperative complications for RHBPPALND, and LHBPPALND was 1 and 7, respectively. Conclusion: Robotic hysterectomy with lymphadenectomy has a faster learning curve in comparison to laparoscopic hysterectomy with lymphadenectomy. The adequacy of surgical staging was comparable between the two surgical methods. RHBPPALND is associated with shorter hospitalization, less blood loss and less intraoperative and major complications, and lower rate of conversion to open procedure. © 2010 Elsevier Inc. All rights reserved.




“Robotic nerve-sparing radical hysterectomy: Feasibility and technique.”

Magrina, J. F., W. Pawlina, et al. (2011).

Gynecologic Oncology.


OBJECTIVE: To describe the anatomy of pelvic autonomic nerves as it applies to nerve-sparing radical hysterectomy, and the technique, feasibility, and results of robotic nerve-sparing radical hysterectomy. METHODS: Prospective evaluation of 6 patients undergoing robotic nerve-sparing radical hysterectomy (type C1) for cervical cancer Stage IB (1B1 in 3 and 1B2 in 3 patients). Pelvic lymphadenectomy was performed in 3 patients and pelvic and aortic in the remaining 3 patients. RESULTS: The operation was completed in all patients. The mean age of the patients was 51.0 (range 33-73) and mean BMI 27.8 (range 23.2-35.1). The mean operating time was 238.6min (range 207-256), mean blood loss 135ml (range 100-150), mean number of lymph nodes was 23.6 (range 19-29), mean hospital stay was 2days (range 1-4). There were no intraoperative complications. Postoperative complications occurred in 1 patient with an ileus who required an extended hospital stay. One patient did not regain normal urinary voidings until the fourth week after surgery. All patients remain free of disease. CONCLUSION: Robotic nerve-sparing radical hysterectomy is safe and feasible. Urinary dysfunction may occur.




“Robotic approach for ovarian cancer: Perioperative and survival results and comparison with laparoscopy and laparotomy.”

Magrina, J. F., V. Zanagnolo, et al. (2011).

Gynecologic Oncology 121(1): 100-105.


OBJECTIVE: Comparison of perioperative outcomes and survival of patients undergoing primary surgical treatment for epithelial ovarian cancer (EOC) by a robotic, laparoscopy, or laparotomy approach. METHODS: Retrospective case-control analysis of 25 patients with EOC undergoing robotic surgical treatment between March 2004 and December 2008. Comparison was made with similar patients treated by laparoscopy and laparotomy and matched by age, body mass index (BMI), and type of procedures between January 1999 and December 2006. RESULTS: The mean operating times were 314.8, 253.8 and 260.7min for robotic, laparoscopy and laparotomy patients, respectively (p<0.05); the mean blood loss was 164.0, 266.7, and 1307.0ml, respectively (p=0.001); the mean length of hospital stay was 4.2, 3.2, and 9.4days, respectively (p=0.001). The overall survival (OS) for robotics, laparoscopy and laparotomy patients was 67.1%, 75.6% and 66.0%, respectively (p=0.08). Patients were subdivided and compared according to the extent of surgery by the type and number of major procedures. Type I and II debulking patients operated by robotics and laparoscopy had improved perioperative outcomes as compared to laparotomy. For patients undergoing a type III debulking, robotic outcomes were not improved over laparotomy. CONCLUSION: Laparoscopy and robotics are preferable to laparotomy for patients with ovarian cancer requiring primary tumor excision alone or with one additional major procedure. Laparotomy is preferable for patients requiring two or more additional major procedures. Survival is not affected by the type of surgical approach.




“Surgical outcomes in gynecologic oncology in the era of robotics: analysis of first 1000 cases.”

Paley, P. J., D. S. Veljovich, et al. (2011).

American Journal of Obstetrics and Gynecology.


OBJECTIVE: We sought to examine outcomes in an expanding robotic surgery (RS) program. STUDY DESIGN: In all, 1000 women underwent RS from May 2006 through December 2009. We analyzed patient characteristics and outcomes. A total of 377 women undergoing RS for endometrial cancer staging (ECS) were compared with the historical data of 131 undergoing open ECS. RESULTS: For the entire RS cohort of 1000, the conversion rate was 2.9%. Body mass index increased over 3 time intervals: T1 = 26.2, T2 = 29.5, T3 = 30.1 (T1:T2, P = .01; T1:T3, P = .0001; T2:T3, P = .037). Increasing body mass index was not associated with increased major complications: T1 = 8.7%, T2 = 4.3%, T3 = 5.7%. In the ECS cohort, as compared with open ECS, women undergoing RS had lower blood loss (46.9 vs 197.6 mL, P < .0001), shorter hospitalization (1.4 vs 5.3 days, P < .0001), fewer major complications (6.4% vs 20.6%, P < .0001), with higher lymph node counts (15.5 vs 13.1, P = .007). CONCLUSION: RS is associated with favorable morbidity and conversion rates in an unselected cohort. Compared to laparotomy, robotic ECS results in improved outcomes.




“Evaluation of the learning curve of total robotic hysterectomy with or without lymphadenectomy for a gynecologic oncology service.”

Rocconi, R. P., C. Meredith, et al. (2011).

Journal of Robotic Surgery: 1-5.


We sought to determine the learning curve for total robotic hysterectomy, bilateral salpingo-oophorectomy (TRH, BSO) with/without lymphadenectomy (LND) for a gynecologic oncology service. Data was collected prospectively and included demographics, surgical data, and timed data points to calculate times for the following categories: total operating room (OR) time, setup time, hysterectomy (HYST) time, lymphadenectomy (LND) time, and console time. Cases were grouped into tens by chronological order and compared. A risk-adjusted cumulative sum (CUSUM) model was used to evaluate learning curves for hysterectomy and lymphadenectomy. The first 155 patients are reported. Average HYST time was 45.2 min and average LND time was 52.4 min. Cases were grouped by each consecutive 10 cases per surgeon (i.e. Group 1 = cases 1-10 for each surgeon). All groups were similar with respect to age, body mass index, stage, grade, cancer type, number of lymph nodes, and uterine weight. All times significantly improved with the increase in number of cases: total OR time (P < 0.001); setup time (P = 0.004); HYST time (P = 0.001); LND time (P = 0.05); console time (P = 0.05). CUSUM analysis demonstrated a learning curve of 14 cases for HYST time and 19 cases for lymphadenectomy. Our data describes the robotic laparoscopic learning curves for both hysterectomy and lymphadenectomy in a gynecologic oncology practice and could be utilized for hospital credentialing. The amount of experience required to achieve maximum time efficiency for robotic lymphadenectomy was greater than that for hysterectomy. A significant improvement was observed in all timed data points collected, and the time to proficiency appears reasonable. © 2011 Springer-Verlag London Ltd.




“Robotics Versus Laparoscopic Radical Hysterectomy with Lymphadenectomy in Patients with Early Cervical Cancer: A Multicenter Study.”

Tinelli, R., M. Malzoni, et al. (2011).

Annals of Surgical Oncology.


BACKGROUND: The aim of this study was to retrospectively compare the safety, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (TLRH) with lymphadenectomy and total robotic radical hysterectomy (RRH) with lymphadenectomy for early cervical carcinoma in a series of 99 consecutive women. MATERIALS AND METHODS: We studied 99 consecutive patients with FIGO stage Ia1 (LVSI), Ia2, Ib1, Ib2, and IIa cervical cancer, 76 of whom underwent TLRH and 23 underwent RRH with pelvic lymph node dissection. Para-aortic lymphadenectomy, with the superior border of the dissection being the inferior mesenteric artery, was performed in all cases with positive pelvic lymph nodes discovered at frozen section evaluation. RESULTS: The mean blood loss was 157 ml in the RRH group (95% confidence interval [95% CI] 50-400) and 95 ml in the TLRH group (95% CI 30-500) (not significant [NS]). The median length of hospital stay was 3 days in the RRH group (95% CI 2-7) and 4 days in the TLRH group (95% CI 3-7) (NS). The mean operating time was 255 min for the TLRH group (95% CI 182-415) compared with 323 min in the RRH group (95% CI 161-433) (P < 0.05). No significant difference was found between the 2 groups when comparing the recurrence rate. CONCLUSIONS: Robotic radical hysterectomy can be considered a safe and effective therapeutic procedure for managing early-stage cervical cancer without significant differences, if compared with laparoscopic radical hysterectomy, in terms of the recurrence rate and intraoperative and postoperative complications, although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcomes of this procedure.




“Robotic-assisted laparoscopic ovarian tissue transplantation.”

Akar, M. E., A. J. Carrillo, et al. (2011).

Fertility and Sterility 95(3): 1120.e1125-1120.e1128.


Objective: To describe a technique for frozen-banked ovarian tissue transplantation using robotic-assisted laparoscopy. Design: Case study. Setting: Academic tertiary care center. Patient(s): A 38-year-old patient in remission for non-Hodgkin lymphoma, whose ovarian tissue had been frozen for 3 years. Intervention(s): Robotic-assisted laparoscopic transplantation of thawed ovarian cortical tissue to the remaining ovary and peritoneum. Main Outcome Measure(s): Resumption of spontaneous menses, follicular development, and ovulation as demonstrated by ultrasound, and serum E2 and P levels. Result(s): The patient experienced cyclic spontaneous menstruation 6 months after the transplantation. Ovulation was confirmed by ultrasound and serum E2 and P levels at month 11 after surgery. Conclusion(s): Robotic-assisted laparoscopic surgery may be a good, minimally invasive alternative for the ovarian tissue transplantation procedure to restore ovarian function. ©2011 by American Society for Reproductive Medicine.




“Robotic surgery for adnexal masses in pregnancy.”

Baldwin, L. A., I. Podzielinski, et al. (2011).

Journal of Robotic Surgery: 1-3.




“Laparoscopic sacrocolpopexy for the treatment of vaginal vault prolapse: With or without robotic assistance.”

Chan, S. S. C., S. M. W. Pang, et al. (2011).

Hong Kong Medical Journal 17(1): 54-60.


Objective: To assess perioperative and medium-term outcome after laparoscopic sacrocolpopexy with or without robotic assistance for vaginal vault prolapse in a Hong Kong tertiary centre. Design Retrospective study. Setting: An urogynaecology unit in Hong Kong. Patients: All women who underwent laparoscopic sacrocolpopexy with or without robotic assistance for vaginal vault prolapse from March 2005 to May 2010. Main outcome measures: The perioperative and medium-term outcomes. Results: A total of 36 women underwent the operation during the study period. The mean operating time was 205 minutes, mean blood loss was 144 mL. The median hospital stay was 4 days. Two women required early re-operation but recovered fully. In all, 35 women were followed up for 29 (standard deviation, 19) months. Three of them (9%) had a recurrence of stage II prolapse, but there was statistically significant improvement in the pelvic organ prolapse quantification assessment for all three compartments of the vagina, and the length of vagina was well preserved. There were no mesh exposure or erosions. The overall objective cure rate of 91% (32/35) was high, and 91% (32/35) were satisfied with the operative outcome. Stress incontinence and voiding difficulty were significantly reduced. Conclusion: Laparoscopic sacrocolpopexy for vaginal vault prolapse is safe, although complications arising from concomitant surgery should not be neglected. High rates of objective cures and patient satisfaction were achieved. There were no mesh exposure or erosions. Laparoscopic sacrocolpopexy should be considered an option for women with vaginal vault prolapse.




“Robot-assisted laparoscopy, natural orifice transluminal endoscopy, and single-site laparoscopy in reproductive surgery.”

Gargiulo, A. R. and C. Nezhat (2011).

Seminars in Reproductive Medicine 29(2): 155-168.


Minimally invasive gynecologic surgery is continuously pushing its limits by embracing ever more sophisticated technology. This is also true for reproductive surgery, arguably the birthplace of gynecologic endoscopy, where minimally invasive treatment of uterine, tubal, ovarian, and peritoneal pathology has long become the gold standard. This article describes in some detail three novel minimally invasive surgery approaches that have seen the light during the past decade: robot-assisted laparoscopic surgery, natural orifice transluminal endoscopic surgery, and single-incision laparoscopic surgery. These fascinating technologies, far from being widely adopted, are sure to generate scientific controversy for years to come. Nonetheless, they follow in the footsteps of the tradition of innovation that is a defining aspect of our specialty and hold the promise to potentially revolutionize the field of reproductive surgery.




“Potential cures for endometriosis.”

Jacobson, T. Z. (2011).

Annals of the New York Academy of Sciences 1221(1): 70-74.


Treatment of endometriosis usually requires highly individualized management and varies depending on the presenting symptoms and the life stage of the patient. Surgical treatment of endometriosis starts with clinical recognition of the condition that may be enhanced by narrow band imaging. Surgery is effective in pain control and enhancing fertility. Tubal ligation or salpingectomy can be considered. Robotic surgery is unlikely to create a cure, but may assist surgery. Medical treatment including aromatase inhibitors may also be effective. Tubal flushing with lipiodol increases fecundity; other immunomodulators and neuromodulators may also be effective. Complementary therapies, however, have not been subjected to randomized clinical trials. Environmental factors, diet, and lifestyle modification may be effective.




“Long-Term Outcomes after Robotic Sacrocolpopexy in Pelvic Organ Prolapse: Prospective Analysis.”

Moreno Sierra, J., E. Ortiz Oshiro, et al. (2011).

Urologia Internationalis.


Objective: To evaluate the feasibility and long-term outcomes of our initial series of robot-assisted laparoscopic sacrocolpopexy. Methods: We conducted a prospective analysis of our series of robotic sacrocolpopexy. Inclusion criteria: patients with grades III and IV cystocele and or other symptomatic pelvic organ prolapse. We performed a transperitoneal four-trocar technique with the Da Vinci robotic system using two polypropylene meshes for fixation to the sacral promontory. The primary outcome was recurrence; secondary outcomes included operating room time, blood loss, conversion to open surgery, complications and length of stay. Results: 31 consecutive procedures were included. Mean patient age was 65.2 (50-81) years. Mean operating room time was 186 (150-230) min. We converted 1 case to laparoscopy (3.2%). There were two major complications (1 acute myocardial infarction and 1 reoperation for excess tension with syncopes), two minor complications (1 wound infection and 1 ileus) and no recurrences at a mean follow-up of 24.5 (16-33) months. Conclusions: Robotic sacrocolpopexy could possibly improve with experience after overcoming the learning curve. There is no doubt it is a reproducible technique, but its safety and efficacy still need to be proven. Our initial series demonstrated good outcomes and no recurrences at 24.5 months of follow-up. Copyright © 2011 S. Karger AG, Basel.




“Robotic sacrocolpoperineopexy with ventral rectopexy for the combined treatment of rectal and pelvic organ prolapse: initial report and technique.”

Reddy, J., B. Ridgeway, et al. (2011).

Journal of Robotic Surgery: 1-7.


The objective of our study is to describe the peri-operative and early postoperative surgical outcomes following robotic sacrocolpoperineopexy with ventral rectopexy for the combined treatment of rectal and pelvic organ prolapse. This was a retrospective cohort study of ten women with symptomatic Stage 2 or greater pelvic organ prolapse and concomitant rectal prolapse who desired combined robotic surgery, at a single institution. The mean age of the subjects was 55.3 ± 19.2 years (range 19-86)  and the mean body mass index was 25.8 ± 5.7 kg/m2. Preoperatively, the women had Stage 2 or greater pelvic organ prolapse and the average length of rectal prolapse was 2.1 ± 1.9 cm. There were no conversions to conventional laparoscopy or laparotomy. The mean operating room time was 307 ± 45 min with an estimated blood loss of 144 ± 68 ml. The average length of stay was 2.4 ± 0.8 days. Preliminary data suggest that robotic sacrocolpoperineopexy with ventral rectopexy is a feasible procedure with minimal operative morbidity for the combined treatment of rectal and pelvic organ prolapse. Longer follow-up is needed to ensure favorable long-term subjective and objective outcomes. © 2011 Springer-Verlag London Ltd.




“Robotic surgery in gynecology – The surgeon sitting at the desk.”

Schollmeyer, T., L. Mettler, et al. (2011).

Roboterchirurgie in der Gynäkologie – Der Operateur am Schreibtisch: 1-5.


Computerized-enhanced robotic surgery using the daVinci robotic surgical system has been applied successfully in urology, general surgery, orthopedics, ophthalmology, neurosurgery and gynecology. Despite rapid advances in urology and general surgery, robotic surgery systems have had limited use in gynecologic surgery although interest is increasing. The use of robotic assistance (RA) in laparoscopy has been proposed to overcome the disadvantages and limitations of traditional laparoscopic surgery (2-dimensional images, hand tremors and dexterity limitations) while still benefiting from the advantages of the minimally invasive technique. Robotic surgery has the potential to facilitate surgical procedures by allowing the surgeon to sit comfortably while visualizing the abdominal and pelvic cavity in three dimensions with magnification. The development of robot-assisted operating systems with a mobile control unit and reusable instruments under the direct visual and tactile control of the surgeon will determine the operating options of the future. © 2011 Springer-Verlag.