Abstrakt Gynekologie Červenec 2010

“New technologies for reproductive medicine: Laparoscopy, endoscopy, robotic surgery and gynecology. A review of the literature.”

Cho, J. E., A. H. A. Shamshirsaz, et al. (2010).

Minerva Ginecologica 62(2): 137-167.


Computer-enhanced telesurgery, called robotic-assisted surgery, is the latest innovation in the minimal invasive surgery field. In gynecology, this machine has been applied in several applications, in the fields of benign gynecology, reproductive medicine, urogynecology, and oncology. The purpose of this paper was to review the published scientific literature regarding robotics and its application to gynecology thus far and summarize findings of this computer enhanced laparoscopic technique. Relevant sources were identified by a Pubmed/Medline search looking at databases from January 1950 to July 2009. A total of 29 papers in benign gynecology were identified, and a total of 44 articles were analyzed involving gynecologic oncology. The estimated blood loss, number of lymph nodes extracted, operating time, length of hospital stay and complications were noted among all the studies. The data shows comparable results between robotic and laparoscopic surgery in terms of estimated blood loss, operative time, length of hospital stay, and complications for gynecologic cancer. Overall, there were more wound complications in the laparotomy approach compared to laparoscopy and robotic assisted laparoscopy. There were more lymphocysts, lymphoceles, and lymphedema in the robotic assisted laparoscopic group compared to the laparoscopy and laparotomy groups in cervical cancer patients. Infectious and lung-related morbidity, postoperative ileus, and bleeding/clot formation was more commonly reported in the laparotomy group compared the other two cohorts in endometrial cancer patients. Computer enhanced technology may enable more surgeons to convert their laparotomies to laparoscopic surgery with its associated benefits. It appears that in the hands of experienced laparoscopic surgeons, final outcomes are the same when using or not using the robot. There is good evidence that robotic surgery facilitates laparoscopic surgery, with equivalent if not better operative time and comparable surgical outcomes, shorter hospital stays, and fewer major complications than those surgeries utilizing the laparotomy approach.




“Turkey’s experience of robotic-assisted laparoscopic hysterectomy: a series of 25 consecutive cases.”

Gocmen, A., F. Sanlikan, et al. (2010).

Archives of Gynecology and Obstetrics 282(2): 163-171.


PURPOSE: To present the outcomes of the first 25 robotic-assisted hysterectomies from Turkey. METHOD: A total of 25 patients who underwent robotic-assisted hysterectomy (RAH) for benign conditions were included in the study. Patients’ demographics, surgical procedures, operative and postoperative complications, hospital stay, conversion to laparotomy, time data including all operative times, uterus weight and estimated blood loss (EBL) were recorded. All hysterectomies were American Association of Gynecologic Laparoscopists type IVE. RESULTS: All hysterectomies were completed robotically with no conversion to laparotomy. The mean and range of the operating time were 104.1 and 47-176 min, respectively. The mean hysterectomy time was 40.5 min (range 14-77). The mean cuff incision time and cuff suturation time were 6.8 min (range 2-18) and 16.4 min (range 7-40), respectively. The mean set-up time was 30.4 min (range 17-41 min). The mean docking time was 4.3 min (range 2-9 min). The mean console time was 74.2 min (range 30-137). The mean and range of the anesthesia time were 133.8 min and 75-210 min, respectively. The averages of EBL and uterus weight were calculated as 38.2 cc and 221.9 g, respectively. Three complications occurred: one postoperative paralytic ileus and the others were peroperative vaginal cuff lacerations during the removal of the specimen through the vagina. CONCLUSION: Robotic-assisted hysterectomy (RAH) is feasible and safe for women with benign uterine pathologies, although it has limitations that may be overcome in the future.




“Robotically assisted hysterectomy in patients with large uteri: outcomes in five community practices.”

Henne, M. B. (2010).

Obstetrics and Gynecology 116(2 Pt 1): 441-442.




“Variance in Abdominal Wall Anatomy and Port Placement in Women Undergoing Robotic Gynecologic Surgery.”

Matthews, C. A., C. M. Schubert, et al. (2010).

Journal of Minimally Invasive Gynecology.


STUDY OBJECTIVES: To estimate whether variability in the size and ratios of the lower and upper abdomen exist in women undergoing robotic gynecologic surgery and whether demographic variables are significantly associated, and to determine the association between abdominal wall dimensions and supraumbilical robotic port placement. DESIGN: Prospective cohort study (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: Seventy-eight women undergoing robotic surgery between May 2008 and March 2009. INTERVENTION: Measurements from the symphysis pubis to the umbilicus (lower abdomen), umbilicus to the xyphoid process (upper abdomen), and distance between the anterior superior iliac crests were obtained at surgery. A multiple linear regression model was created to determine the relationships between abdominal wall measurements, demographic variables, and need for supraumbilical robotic port placement. MEASUREMENTS AND MAIN RESULTS: Fifty-six white and 22 black women were enrolled. Mean lower abdominal length was significantly affected by body mass index (BMI) (p < .001) and race (p = .006), with white women having longer measurements (17.1 cm vs 15 cm). Mean lower abdominal width was independent of age (p = .95) or race (p = .98), but was significantly correlated with BMI (p < .001). Mean upper abdominal length correlated with BMI (p < .001) and age (p = .03) but not race (p = .13). Ratios of bottom to top were significantly affected by race (p = .002) and age (p = .008) but not BMI (p = .07). Adjustments to port placement above the umbilicus were made in 44 of the 74 women (59.5%). Those who required supraumbilical port placement had a significantly shorter mean (SD) distance between the symphysis pubis and the umbilicus (14.99 [1.36] vs 18.55 [2.21]; p < .001). CONCLUSIONS: Significant variability in abdominal wall anatomy exists in women undergoing robotic gynecologic surgery, and the need for supraumbilical robotic port placement is common.




“Sacral osteomyelitis after robotically assisted laparoscopic sacral colpopexy.”

Nosseir, S. B., Y. H. Kim, et al. (2010).

Obstetrics and Gynecology 116(2 Pt 2): 513-515.


BACKGROUND:: Osteomyelitis associated with using synthetic mesh for laparoscopic sacral colpopexy is rare. CASE:: We present a patient who developed Staphylococcus sacral osteomyelitis after sacral colpopexy with synthetic mesh and titanium tack fixation to the sacral promontory in the absence of mesh erosion or fistula formation. The patient presented with low back pain 6 weeks postoperatively. Magnetic resonance imaging, bone aspirate, and culture confirmed sacral osteomyelitis and discitis 10 weeks after surgery. The patient underwent 8 weeks of outpatient antibiotic treatment. Six months after surgery, serial laboratory values have demonstrated excellent response to antibiotic treatment, and the patient has clinically improved without the need for mesh removal. CONCLUSION:: We recommend a high index of suspicion for osteomyelitis in patients who present with back pain after sacral colpopexy. Osteomyelitis can occur as a complication of laparoscopic, robotic sacral colpopexy using mesh in the absence of abscess or fistula formation.




“Robotically assisted hysterectomy in patients with large uteri: outcomes in five community practices.”

Payne, T. N. (2010).

Obstetrics and Gynecology 116(2 Pt 1): 442.




“Instituting a robot-assisted surgery programme at a tertiary care cancer centre.”

Dupont, N. C., K. A. Guru, et al. (2010).

Int J Med Robot.


BACKGROUND: The initial experience of a gynaecological oncology robotic surgery programme at a tertiary care cancer centre is described. METHODS: A retrospective study was performed to evaluate the perioperative outcomes of 76 patients offered robot-assisted surgery. RESULTS: Seventy-three patients underwent robot-assisted surgery; three cases were converted to laparotomy; 51% of patients underwent treatment for endometrial cancer; 18% had ovarian cancer risk reduction surgery; and 8% were treated for uterine leiomyomata. Median body mass index (BMI) was 30. Median estimated blood loss, operative time, and length of stay were 150 ml, 195 min and 1 day, respectively. The total major complication rate was 6.8% and the total minor complication rate was 15.1%. CONCLUSION: Robot-assisted surgery is safe and appropriate for gynaecological patients undergoing surgical management. A gynaecological oncology robot-assisted programme can be easily established in a tertiary care cancer centre. Copyright (c) 2010 John Wiley & Sons, Ltd.




“Surgery of the cancer of uterine neck. Past, present and future.”

Escudero Fernández, M. (2009).

Cirugía del cancer de cuello uterino. Pasado, presente y futuro. 126(1): 147-156.


The evolution of the surgery of the cancer of cervix has passed for several stages. First the boarding was indisputably vaginal. Thanks to the anestesea, antibioterapia and trasfusion was produced a change that has come to our days to the abdominal route with Wertheim Meigs’s intervention. From 1987 Dargent he introduced the route laparoscopica, the conservative surgery and the return to the vaginal boarding. Today the robotic surgery is imposed with the Da Vinci.




“Comparison of robotic-assisted surgery outcomes with laparotomy for endometrial cancer staging in Turkey.”

Gocmen, A., F. Sanlikan, et al. (2010).

Archives of Gynecology and Obstetrics.


PURPOSE: To compare the results of patients on whom staging was applied by robotic-assisted laparoscopic surgery and laparotomy for endometrial cancer. METHOD: The study included 10 patients who had undergone robotic-assisted endometrial staging (group 1) and 12 patients staged by open surgery (group 2). Demographical characteristics and operative outcomes of all patients were compared. Body mass index, age, previous abdominal surgeries, histopathologic characteristics, performed operative procedure, operation time, complications, hospitalization duration, estimated blood loss and number of resected lymph nodes were recorded for all patients. RESULTS: Mean age of the patients in the robotic surgery group was 55.7 years (37-66) and in the laparotomy group 56.4 years (47-75). Body mass index was calculated as 32.7 kg/m(2) (24.5-40.3) in group 1 and 30.3 kg/m(2) (25.9-35.8) in group 2. Total duration of operation was 234.6 min (137-300) and 168.5 min (102-232) in group 1 and 2, respectively. Mean duration of hospitalization in group 1 was 2.8 days (2-5) and in group 2 was 8.8 days (6-13). Estimates of blood loss were 95 ml (20-210 ml) in the robotic surgery group and 255 ml (80-420) in the other group. The mean number of resected lymph nodes was 42 (13-86) and 46.5 (26-107) in the robotic-assisted surgery group and laparotomy group, respectively. None of the cases in the robotic-assisted endometrial staging group required transition to laparotomy. CONCLUSION: Robotic surgery may be preferred over laparotomy with respect to the advantages observed in the duration of hospitalization, estimated amount of blood loss and complications. There was no significant difference between the two methods in terms of number of resected lymph nodes. Despite the limited number of patients in this study, these results are important as they represent the first data on robotic surgery in Turkey.