“Surgical techniques: Robot-assisted laparoscopic colposacropexy with the da Vinci® surgical system.”
Matthews, C. A. (2009).
Journal of Robotic Surgery 3(1): 35-39.
Colposacropexy is the gold-standard operation for repair of apical vaginal support defects. While it is feasible to perform this operation using conventional laparoscopic techniques, a limited number of surgeons have mastered the advanced minimally invasive skills that are required. Introduction of the da Vinci® robotic system with instruments that have improved dexterity and precision and a camera system with three-dimensional imaging presents an opportunity for more surgeons treating women with pelvic organ prolapse to perform the procedure laparoscopically. This paper will outline a technique that is exactly modeled after the open procedure for completion of a robotic-assisted colposacropexy using the da Vinci® surgical system. © 2009 Springer-Verlag London Ltd.
“A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy.”
Estape, R., N. Lambrou, et al. (2009).
Objective: To compare robotic radical hysterectomy to laparoscopic and radical abdominal hysterectomy in the treatment of cervical cancer. Methods: Prospective analyses of thirty-two consecutive patients undergoing robotic radical hysterectomy were compared to 17 patients undergoing laparoscopic radical hysterectomy and 14 patients undergoing radical abdominal hysterectomy. Results: Operative time for the robotic group was 2.4 h ± 0.8 and not significantly different from the laparoscopic group at 2.2 h ± 0.7, nor the laparotomy group (1.9 h ± 0.6, p = 0.05). The estimated blood loss for patients undergoing robotic hysterectomy was 130 cm3 ± 119.4. This was significantly less than the laparotomy group (621.4 mL ± 294.0, p < 0.0001), but not the laparoscopic group (209.4 mL ± 169.9, p = 0.09). The robotic group had an average of 32.4 total nodes retrieved, as compared to 18.6 and 25.7 nodes retrieved in the laparoscopy and laparotomy cohorts, respectively. All differences were significant (p < 0.0001 and p < 0.05). Mean length of hospital stay was 2.6, 2.3 and 4.0 days in the robotic, laparoscopic, and laparotomy cohorts respectively. The incidence of postoperative complications was less in the robotic cohort (18.8%) as compared to the laparoscopic (23.5%), and laparotomy cohorts (28.6%). Conclusions: Robotic total laparoscopic radical hysterectomy with pelvic and para-aortic lymphadenectomy is feasible and may be preferable over laparoscopic or radical abdominal hysterectomy. © 2009 Elsevier Inc. All rights reserved.
“Role of Robotic Surgery in Endometrial Cancer.”
Lin, P. S., M. T. Wakabayashi, et al. (2009).
Current Treatment Options in Oncology: 1-11.
Uterine cancer is the most common gynecologic cancer in women in the United States with an estimated number of 40,100 women diagnosed in 2008, the great majority of which belongs to endometrial classification. The traditional approach to treatment of endometrial cancer has been primarily surgery via an open, laparotomy incision. Minimally invasive approaches with smaller incisions, i.e., laparoscopy for the management of endometrial cancer was initially reported in 1992; however, its adoption has been slow due to the prolonged learning curve needed to become proficient in such a technique. Robotic-assisted surgery, a further advancement of traditional laparoscopy, using computer-based controls has been developed enabling the performance of complex procedures that otherwise had been too difficult to accomplish in a minimally invasive fashion. Robotic-assisted laparoscopic radical prostatectomy is one such example that has gained rapid acceptance in recent years. Although the use of robotic-assisted laparoscopy for endometrial cancer is still in its early phase, this approach is anticipated to become similarly, a common approach to the management of endometrial cancer in the future. © 2009 Springer Science+Business Media, LLC.
“A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer.”
Lowe, M. P., D. H. Chamberlain, et al. (2009).
OBJECTIVE: The purpose of the study is to report a multi-institutional experience with robotic-assisted radical hysterectomy to treat patients with early stage cervical cancer with respect to perioperative outcomes. METHODS: A multi-institutional robotic surgical consortium consisting of five board-certified gynecologist oncologist in distinct geographical regions of the United States was created to evaluate the utility of robotics for gynecologic surgery (benign and malignant). Between April 2003 and August 2008, a total of 835 patients underwent robotic surgery for benign gynecologic disorders and/or gynecologic malignancies by a surgeon in the consortium. IRB approval was obtained and data was collected in a prospective fashion at each institution. For the purposes of the study, a multi-institutional HIPPA compliant database was then created for all patients that underwent robotic-assisted surgery between the April 2003 and August 2008. This database was queried for all patients who underwent a robotic-assisted type II or III radical hysterectomy for Stage IA1 (+vsi)-IB2 cervical carcinoma. Forty-two patients were identified. Records were then reviewed for demographic data, medical conditions, prior abdominal or pelvic surgeries, and follow-up. The perioperative outcomes analyzed included: operative time (skin-skin), estimated blood loss (EBL), length of hospital stay, total lymph node count, conversion to laparotomy, and operative complications. RESULTS: From a database of 835 patients who underwent robotic surgery by a gynecologic oncologist, a total of 42 patients who underwent a robotic-assisted type II (n=10) or type III (n=32) radical hysterectomy for early stage cervical cancer were identified. Demographic data demonstrated a median age of 41 and a median BMI of 25.1. With regard to stage, seven patients (17%) were Stage IA2, twenty-eight patients (67%) were Stage IB1 and six patients (14%) were Stage IB2. There was a single patient with Stage IA1 cervical cancer with vascular space invasion who underwent a type II radical hysterectomy. The overall median operative time was 215 min. The overall median estimated blood loss was 50 cc. No patient received a blood transfusion. The median lymph node count was 25. The median hospital stay was 1 day. Positive lymph nodes were detected in 12% of the patients. Pelvic radiotherapy or chemo-radiation was given to 14% of the patients based on final surgical pathology. Intraoperative complications occurred in 4.8% of the patients and included one conversion to laparotomy (2.4%) and one ureteral injury (2.4%). Postoperative complications were reported in 12% of the patients and included a DVT (2.4%), infection (7.2%), and bladder/urinary tract complication (2.4%) The conversion rate to laparotomy was 2.4%. CONCLUSIONS: Robotic-assisted radical hysterectomy is associated with minimal blood loss, a shortened hospital stay, and few operative complications. Operative time and lymph node yields are acceptable. This data suggests that robotic-assisted radical hysterectomy may offer an alternative to traditional radical hysterectomy. This series contributes to the growing literature on robotic-assisted radical hysterectomy and prospective comparisons with traditional radical hysterectomy are needed.
“Robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy with short and long term morbidity data.”
Persson, J., P. Reynisson, et al. (2009).
Gynecologic Oncology 113(2): 185-190.
Objective: To evaluate feasibility and morbidity of robot assisted laparoscopic radical hysterectomy. Methods: From December 2005 to September 2008 robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy was performed on 80 women. Using a prospective protocol, and an active investigation policy for defined adverse events, perioperative, short and long term data were obtained. Results: Time for surgery (skin to skin) reached 176 and 132 min after 9 and 34 procedures respectively. All tumours were radically removed. Median number of retrieved lymph nodes was 26 (range 15-55). All women had an early follow up (1-3 months) and 43 of eligible 46 women (93%) had a long term follow up (? 12 months). In 33 of 80 women (41%) the peri/postoperative period was uneventful. The remainder had one or more mainly mild adverse events, most commonly from the vaginal cuff (n = 17, 21%) or the lymphatic system (n = 16, 20%). The proportion of uneventful cases increased significantly over time. Five women were resutured for dehiscence of the vaginal cuff, two women were reoperated for trocar site hernias and one woman had a ureter stricture that resolved following stent treatment. Eight women (14%) needed 60 days or more to resume spontaneous voiding. One 72-year old woman with disseminated endometrial cancer on autopsy died of pulmonary embolism 31 days after surgery. Conclusions: Robot assisted laparoscopic radical hysterectomy is a feasible alternative to conventional laparoscopy and open surgery. Effort should be made to ensure proper closure of the vaginal cuff, trocar sites and to develop nerve sparing techniques. © 2009 Elsevier Inc. All rights reserved.