Abstrakt Gynekologie Leden 2011

“Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes.”

Barakat, E. E., M. A. Bedaiwy, et al. (2011).

Obstetrics and Gynecology 117(2 Pt 1): 256-266.


OBJECTIVE: : To compare the surgical outcomes of robot-assisted laparoscopic myomectomy (robot-assisted), standard laparoscopic myomectomy (laparoscopic), and open myomectomy (abdominal). METHODS: : Myomectomy patients were identified from the case records of the Cleveland Clinic and stratified into three groups. Operative and immediate postoperative outcomes were compared. Data analysis was performed using analysis of variance, Kruskal-Wallis analysis of ranks, chi, and Fisher exact tests where appropriate. RESULTS: : From a total of 575 myomectomies, 393 (68.3%) were abdominal, 93 (16.2%) were laparoscopic, and 89 (15.5%) were robot-assisted. The three groups were comparable regarding the size, number, and location. Significantly heavier myomas were removed in the robot-assisted group (223 [85.25, 391.50] g) compared with the laparoscopic group (96.65 [49.50, 227.25] g, P<.001) and were lower than in the abdominal group (263 [ 90.50, 449.00] g, P=.002). Higher blood loss was reported in the abdominal group compared with the other two groups, with a median (interquartile range) of blood loss in milliliters of 100 (50, 212.50), 200 (100, 437.50) and 150 (100, 200) in the laparoscopic, abdominal, and robot-assisted groups, respectively. The actual surgical time in minutes was 126 (95, 177) in the abdominal group, 155 (98, 200) in the laparoscopic group, and 181 (151, 265) in robot-assisted group (P<.001). Patients in the abdominal group had a higher median length of hospital stay of 3 (2, 3) days, compared with 1 (0, 1) day in the laparoscopic group and 1 (1, 1) days in the robot-assisted group (P<.001). CONCLUSION: : Robotic-assisted myomectomy is associated with decreased blood loss and length of hospital stay compared with traditional laparoscopy and to open myomectomy. Robotic technology could improve the utilization of the laparoscopic approach for the surgical management of symptomatic myomas. LEVEL OF EVIDENCE: : II.




“Surgical technique enhances the efficiency of robotic hysterectomy.”

Feuer, G., P. Hernandez, et al. (2011).

Int J Med Robot.


BACKGROUND: The purpose of this study was to evaluate the benefits and morbidity associated with a novel technique for a hysterectomy designed specifically for a robotic-assisted laparoscopic procedure. Recent studies have compared robotic-assisted laparoscopic hysterectomy vs. open hysterectomy. We have developed a surgical technique that has enabled us to efficiently decrease the standard operative time. METHODS: All patients (55) underwent a robotic-assisted hysterectomy utilizing a novel surgical technique with four specific components, inclusive of the Hem-o-lok((R)) locking clip. RESULTS: This surgical technique has enabled us to efficiently decrease the standard operative time to an average of 80.9 +/- 3.44 min with an estimated blood loss of 63.5 +/- 3.76 ml and a hospital stay of 1.3 +/- 0.15 days, with minimal complications during surgery (1.8%). CONCLUSION: We have provided an efficient technique that is safe, easily reproducible and comparable to open hysterectomy operation times. Copyright (c) 2011 John Wiley & Sons, Ltd.




“Long-term outcomes of robotic-assisted laparoscopic sacrocolpopexy with a minimum of three years follow-up.”

Shimko, M. S., E. C. Umbreit, et al. (2011).

Journal of Robotic Surgery: 1-6.


We describe efficacy and safety of robotic-assisted laparoscopic vaginal vault prolapse repair with long-term follow-up. We reviewed the records of 40 consecutive patients with posthysterectomy vaginal vault prolapse who underwent a robotic-assisted laparoscopic sacrocolpopexy at our institution between September 2002 and September 2006. Patient analysis focused on complications, patient satisfaction, and morbidity, with a minimum of 36 months’ follow-up. Median follow-up was 62 months (range 36-84) and mean age was 67 (43-83) years. Mean operating time was 3.1 (2.15-5) h with a median operating time of 2.9 h. All but four were discharged home on postoperative day one; three patients left on postoperative day two and one left on postoperative day seven. Three developed recurrent grade 3-4 rectoceles and two vaginal extrusion of mesh. Thirty-eight of the 40 patients (95%) were satisfied with their outcome. Robotic-assisted laparoscopic sacrocolpopexy is a minimally invasive technique for vaginal vault prolapse repair, combining the advantages of open sacrocolpopexy with the decreased morbidity of laparoscopy. We found a short hospital stay, low complication rates, and high patient satisfaction with a minimum of 3 years’ follow-up. © 2011 Springer-Verlag London Ltd.




“Surgical staging of endometrial cancer: robotic versus open technique outcomes in a contemporary single surgeon series.”

Goel, M., T. W. Zollinger, et al. (2011).

Journal of Robotic Surgery: 1-6.


Patients prefer robotic surgery due to perceived cosmetic advantages and quicker resumption of regular activity. We compared the results of hysterectomy and surgical staging for endometrial cancer using robotic versus open techniques in patients operated on by a single surgeon. A retrospective clinical data analysis was performed of all patients who underwent surgical staging for endometrial cancer. Patients selected for open techniques underwent surgery between January 2003 and December 2005, whereas patients selected for da Vinci robotic surgery were operated on between June 2006 and June 2008. The study was approved by the Institutional Review Board (IRB). The preoperative diagnosis of endometrial cancer was confirmed using endometrial biopsy. Data were collected and comparative analyses were made using mean or chi-squared test or other appropriate statistical techniques. The study population consisted of 97 patients (open, N = 38; robotic, N = 59). Mean age was 66.5 ± 1.97 versus 59.5 ± 1.43 years, mean parity was 2.11 versus 1.93, and mean body mass index (BMI) was 32.2 ± 2.03 versus 39.3 ± 2.03 (P = 0.02) for open versus robotic surgery, respectively. Operating time and lymph node (LN) yield was 175.24 ± 4.6 versus 185.27 ± 4.4 min, number of pelvic LNs were 8.6 versus 11.34, and aortic LNs were 3.5 versus 1.9 in the open versus robotic groups, respectively. Although mean BMI was higher, blood loss, complications, and hospital stay were significantly lower for patients undergoing robotic surgery. Overall, complications occurred in 5/38 (13%) patients in the open group and 2/59 (3%) patients in the robotic group. Of the two complications in the robotic group, there was one injury to the external iliac vein requiring open surgical management with blood transfusion resulting in a hospital stay of 7 days; however, no other patient required blood transfusion in either surgical group. Robotic surgery results in less blood loss and shorter hospital stay and yields comparable number of lymph nodes, which are adequate for staging. It also results in reduced surgical risks in patients with higher BMI who are prone to higher co-morbidities. Robotic surgery is a useful minimally invasive tool for the comprehensive surgical staging of patients with endometrial cancer. © 2011 Springer-Verlag London Ltd.




“Robotic uterine artery preservation and nerve-sparing radical trachelectomy with bilateral pelvic lymphadenectomy in early-stage cervical cancer.”

Hong, D. G., Y. S. Lee, et al. (2011).

International Journal of Gynecological Cancer 21(2): 391-396.


OBJECTIVE: : The aim of the study was to evaluate the safety and feasibility of robotic uterine artery preservation and nerve-sparing radical trachelectomy with pelvic lymphadenectomy using the da Vinci surgical system. METHODS: : Three patients who were diagnosed with early-stage cervical cancer underwent robotic uterine artery preservation and nerve-sparing radical trachelectomy with bilateral lymphadenectomy from January 2010 to March 2010. The data were compared with those of 4 cases of total laparoscopic nerve-sparing radical trachelectomy that were performed from July 2004 to May 2005 and were previously reported. RESULTS: : In the robotic group, the mean console time was 275 minutes (range, 240-305 minutes). The mean postoperative hemoglobin change was 0.4 g/dL (range, 0.2-0.6 g/dL). The mean estimated blood loss was 23 mL (range, 15-40 mL), which is less than that of the laparoscopic group. There were no metastases detected in any of the cases, and the resection margins were negative in both groups. CONCLUSIONS: : The robotic uterine artery preservation and nerve-sparing radical trachelectomy with pelvic lymphadenectomy were efficient in reducing blood loss and feasible methods such as other approaches.




“Robot-assisted laparoscopy in Gyn Oncologic Surgery: Review.”

Lambaudie, E., F. Cannone, et al. (2010).

L’assistance robotisée en chirurgie oncogynécologique: revue: 1-8.


The laparoscopic approach, over the past 20 years, has become, in Gyn Oncologic Surgery, a gold standard for several teams. Introduced 10 years ago, robot-assisted laparoscopy is increasingly used in the gynecologic surgical field. For the surgeon, the advantages of this intuitive robotic surgery are the three-dimensional approach, the precision of the dissection with robotic instrument articulation, and a shorter learning curve compared to conventional laparoscopy. For the patients, a quicker postoperative recovery, less postoperative pain, and lower blood loss compared to laparoscopy seems to emerge. This review summarizes all the published results of robotic assistance applied to cervical and endometrial cancer surgical management. © 2010 Springer Verlag France.




“Robot-assisted Laparoscopic Staging Surgery for Endometrial Cancer-A Preliminary Report.”

Lee, C. L., C. M. Han, et al. (2010).

Taiwanese Journal of Obstetrics and Gynecology 49(4): 401-406.


Objective: The robotic surgical system is reported to overcome some technical difficulties in traditional laparoscopic hysterectomy. This study aimed to evaluate the feasibility and surgical outcomes of a robotic surgery program for endometrial cancer. Materials and Methods: Patients with endometrial cancer with the intention to receive treatment using robotassisted laparoscopic staging surgery were recruited in a university hospital from July 2007 to August 2008. All of these surgeries were performed with the da Vinci system. Results: Six patients (mean age, 47.5 ±1.4 years; mean body mass index, 26.2 ±3.5 kg/m<sup>2</sup>) were enrolled and completed robot-assisted laparoscopic staging surgery. The robot docking time was 45.0 ±13.6 minutes and the robot-assisted operation time was 200.3 ±30.0 minutes. The mean estimated blood loss was 180.0 ±147.6 mL. The mean number of lymph nodes retrieved was 23.2 ±7.4. No laparoconversion and no intraoperative or postoperative complications occurred. All patients were alive and free of disease up to the date of this report, at a median follow-up of 6.5 months (range, 5-17 months). Conclusion: Robot-assisted laparoscopic staging surgery is a feasible treatment and helps overcome the technical limitations in conventional laparoscopy for endometrial cancer. © 2010 Taiwan Association of Obstetric &amp; Gynecology.




“Side-docking in robotic-assisted gynaecologic cancer surgery.”

Leon Woods, D., J. Y. Hou, et al. (2011).

Int J Med Robot.


BACKGROUND: The majority of previous experience with the robotic-sssisted laparoscopic technique for gynaecological procedures has utilized a method in which the robot is centrally located (CD) between the patient’s legs. METHODS: Twelve consecutive patients undergoing robotic-assisted procedures for gynaecological malignancies were positioned in a side-docking (SD) fashion, in which the robot is positioned lateral to the patient. The relevant clinical parameters were collected and compared to the previous 12 patients undergoing surgery using the conventional, centre-docking (CD) technique. RESULTS: Specimen retrieval time for larger uteri was reduced in the SD group compared to the CD group (p = 0.03). Total operative times were slightly lower in the SD group and specimen retrieval times for all uterine weights were unchanged when compared to the CD group. Statistical significance was not observed. CONCLUSIONS: Side-docking is an alternative to the conventional centre-docking approach in robotic-assisted surgery. Its use may facilitate larger specimen retrieval while decreasing operative time and associated costs. Copyright (c) 2011 John Wiley & Sons, Ltd.




“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. (2010).

Gynecologic Oncology.


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

Magrina, J. F., V. Zanagnolo, et al. (2010).

Gynecologic Oncology.


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 260.7 min for robotic, laparoscopy and laparotomy patients, respectively (p < 0.05); the mean blood loss was 164.0, 266.7, and 1307.0 ml, respectively (p = 0.001); the mean length of hospital stay was 4.2, 3.2, and 9.4 days, 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. © 2010.




“Robot assisted laparoscopy in radical hysterectomy for early uterine cervical cancer: feasibility and role in preservation of pelvic nerve fibres.”

Merlot, B., F. Narducci, et al. (2010).

Faisabilité et intérêt de préserver les fibres nerveuses pelviennes au cours d’hystérectomies élargies par cœlioscopie robot-assistée pour cancer du col utérin précoce: 1-8.


Objective: To study the feasibility of preservation of the pelvic nerve plexuses in robot-assisted radical hysterectomy and potential reduction in urinary tract morbidity. Methods: This study was carried out between February 2008 and August 2010 in two referral centres for gynaecological cancer. All the patients underwent robot-assisted radical hysterectomy. This was either primary surgery with pelvic clearance for a cervical cancer of less than 2 cm or repeat surgery after negative pelvic node clearance and vaginal brachytherapy for cervical cancer measuring 2 to 4 cm. During each procedure, we tried to identify and preserve the pelvic nerve plexuses (nerve sparing), which are partly responsible for normal bladder function. The urinary catheter was routinely removed on the second post-surgical day. Residual urine volume was recorded routinely after each of the first two spontaneous bladder voidings. Results: Fifty patients underwent robot-assisted radical hysterectomy during the period of this study. Identification and anatomical preservation of the pelvic nerve fibres was achieved in each case. It was not necessary on any occasion to convert the procedure into a laparoscopy or laparotomy. The median age of the patients was 45 years (33-68), and the median body mass index was 23.8 (17.7-39.4). FIGO stages were IA1 in 2 patients (4%), IB1 in 41 (82%), IIA in 1 patient (2%) and IIB in the remaining 6 (12%). The mean size of the cervical tumour was 20 mm (4-40). Twenty-one patients (42%) had pre-operative brachytherapy. The mean duration of surgery was 298 minutes (135-405), estimated blood loss 108 ml (30-1,500) and the number of pelvic nodes removed 17.2 (4-41). The median hospital stay was 4.2 days. The complication rate was 42%. We recorded dysuria in 12% of the cases. Conclusion: With robotic assistance during radical hysterectomy for uterine cervical cancer of less than 4 cm, it seems to be possible to preserve the nerve fibres of the pelvic plexuses, even after brachytherapy. More than 88% of the patients had no post-micturition bladder residue (less than 100 ml) after the first postoperative spontaneous voiding. © 2010 Springer Verlag France.




“The twenty-first century role of Piver-Rutledge type III radical hysterectomy and FIGO stage IA, IB1, and IB2 cervical cancer in the era of robotic surgery: a personal perspective.”

Piver, M. S. and A. Ghomi (2010).

Journal of Gynecologic Oncology 21(4): 219-224.


Type III radical hysterectomy reported in 1974 by Piver, Rutledge, and Smith is considered worldwide by many as the standard surgical therapy for invasive cervical carcinoma stage IB and IIA. With the increasing number of robotic surgeries being performed for early stage cervical cancer worldwide, the purpose of the paper is to present our personal perspective of the 21st century role of Piver-Rutledge type III radical hysterectomy for stage IB cervical cancer in the era of robotic surgery using the da Vinci robot.




“Simulation training for gynecologic surgery.”

Cohen, S. L., C. G. C. Chi, et al. (2010).

Contemporary Ob/Gyn 55(9): 30-38.




“Gynecologic robotic surgery and our initial experience.”

Pilka, R. and P. Dzvinčuk (2010).

Gynekologická robotická chirurgie a naše první zkušenosti 75(6): 512-517.


Objective: The objective of this article is to review the recent adoption, experience, and applications of robot-assisted laparoscopy in gynecologic surgery. Design: Review article. Setting: Department of gynekology and obstetrics, University hospital and Medical faculty Palacky University, Olomouc. Methods: Review of literature and our initial experience with robotic surgery. Results: Robotic-assisted laparoscopic surgeries in gynecology include benign hysterectomy, myomectomy, tubal reanastomoses, radical hysterectomy, lymph node dissections, and sacrocolpopexies. Robot-assisted gynecologic surgery is often associated with longer operating room time but generally similar clinical outcomes, decreased blood loss, and shorter hospital stay when compared to open or laparoscopic surgery. We comment on our first 37 robot assisted procedures. Conclusions: Well-designed, prospective studies with well-defined clinical, long-term outcomes, including complications, cost, pain, return to normal activity, and quality of life, are needed to fully assess the value of this new technology.