Abstrakt Gynekologie Prosinec 2009

“Da Vinci S robotic surgery in the treatment of benign and malignant gynecologic tumors.”

Gortchev, G., S. Tomov, et al. (2009).

Gynecological Surgery: 1-5.


The objective of this work is to present and analyze our da Vinci S robotic surgery results in the treatment of gynecologic tumors for a 1-year period. Fifty-one patients underwent da Vinci S (Intuitive Surgical, USA) robotic surgery at the Medical University-Pleven Gynecologic Oncology Clinic from January 2008 to January 2009. Robot-assisted radical hysterectomy with total pelvic lymph node dissection was performed in 28 (54.9%) of them, robot-assisted total hysterectomy in 21 (41.2%), and robot-assisted pelvic lymph node dissection in two (3.9%). The average length of the operative intervention, from the beginning of the CO2 insufflation of the abdomen to closing trocar skin incision was 119.89 min (± 43.441) and mean console time was 76.56 min (± 32.904). The average patient body weight was 70.56 kg (± 18.272; range, 41-114) with mean body mass index (BMI) of 27.30 (± 6.938). No significant difference was observed between the BMI and operative time (p = 0.49). No significant intra-operative complications were registered. An ureterovaginal fistula was diagnosed on the 10th postoperative day in one of the patients (2%). Robot-assisted endoscopic gynecologic surgery is a modern and advanced method for operative treatment of benign and malignant gynecological tumors. It is appropriate for obese patients as the obesity is not related to a prolonged operative time. © 2009 Springer-Verlag.




“Robotic radical hysterectomy for cervical cancer.”

Estape, R. and N. Lambrou (2009).

Gynecol Oncol.




“Robot assisted laparoscopic transperitoneal para-aortic lymphadenectomy in the management of advanced cervical carcinoma.”

Fastrez, M., J. Vandromme, et al. (2009).

European Journal of Obstetrics Gynecology and Reproductive Biology 147(2): 226-229.


Objectives: Adequate staging of advanced cervical cancer is essential in order to optimally treat the patient. FIGO clinical staging, imaging techniques such as CT scan, MRI and PET sometimes underestimate the extension of tumors. The presence of para-aortic lymph node metastases in advanced cervical cancer identifies patients with poor prognosis who need to be treated aggressively. Laparoscopic para-aortic lymph node dissection is now proposed as a diagnostic tool in many guidelines. We evaluated the feasibility and safety of a robot assisted laparoscopic transperitoneal approach to para-aortic lymph node dissection. Study design: Eight patients with advanced cervical carcinoma who were eligible for primary pelvic radiotherapy combined with concurrent cisplatin chemotherapy or pelvic exenteration underwent a pre-treatment robot assisted transperitoneal laparoscopic para-aortic lymphadenectomy. Results: We isolated from 1 to 38 para-aortic nodes per patient and had one para-aortic node positive patient who was treated with extended doses of pelvic radiotherapy. We did not encounter any major complications and post-operative morbidity was low. Conclusions: Robot assisted transperitoneal laparoscopic para-aortic lymphadenectomy is feasible and provides the surgeon with greater precision than classical laparoscopy. Larger prospective multicentric trials are needed to validate the generalised usefulness of this technique. © 2009 Elsevier Ireland Ltd. All rights reserved.




“Overcoming technical challenges with robotic surgery in gynecologic oncology.”

Finan, M. A. and R. P. Rocconi (2009).

Surgical Endoscopy: 1-5.


Background: The majority of data published on robotic surgery in gynecologic oncology has focused on patient outcomes and surgical data. We have found that technical challenges due to the complexity of the robotic technology create a separate set of issues, adding time and difficulty to the actual surgical procedure. This study focuses on these technical problems and identifies pitfalls and potential solutions in robotics. Methods: All patients who underwent robotic surgery for gynecologic oncology indications from August 2006 through July 2008 were eligible for inclusion in the study. Data collected prospectively included demographics, surgical and clinicopathologic data, and technical problems with the robotic equipment. Results: One hundred thirty-seven patients underwent robotic surgery during the study period. A total of 11 cases (8.02%) were associated with problems with robotic technology: 2/11 (18.2%) involved malfunction of robotic arms, 2/11 (18.2%) involved light or camera cords, and the remainder included a variety of problems, including malfunction of Maylard bipolar instrument [1/11 (9.1%)], power failure requiring reboot of robot [1/11 (9.1%)], port problems [2/11 (18.2%)], and 3/1 (27.3%) had miscellaneous problems. An estimated average of 25 min was added to each of these 11 cases in order to solve robot-related technological problems. No cases required conversion to laparotomy. All problems were solved by the robotic surgeon with the assistance of robotic surgery staff. Conclusions: Surgeons performing robotic surgery must become familiar with troubleshooting robotic technology. Several issues related to technical problems may arise, delaying progression of the case, and potential solutions were identified. As this technology is implemented, robotic surgeons must be trained to solve problems related to the robotic technology and associated equipment. Failure to do so may add time and technical difficulty to robotic cases. © 2009 Springer Science+Business Media, LLC.




“Operative treatment of endometrial cancer.”

Hasenbein, K. and C. Köhler (2009).

Operative Therapie des Endometriumkarzinoms 15(9): 865-876.


Surgery is the therapy of choice in the primary treatment of patients with endometrial cancer. With the rising incidence of obesity, the number of patients with endometrial cancer will also increase. However, operations in obese patients are more challenging. Laparotomy as standard therapy in patients with endometrial cancer stages I and II should be replaced by laparoscopic approaches. Laparoscopy is oncologically equivalent to open procedures and offers many advantages to patients, especially those with relevant comorbidities. Robotic surgery for endometrial cancer is still under evaluation. The most controversial point of treatment today is the indication for and extent of lymphadenectomy in different stages. In advanced tumor stages, optimal debulking should be performed to improve the effectiveness of adjuvant chemotherapy and/or radiation therapy. © 2009 Springer Medizin Verlag.




“Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: Analysis of surgical performance.”

Holloway, R. W., S. Ahmad, et al. (2009).

Gynecol Oncol 115(3): 447-452.


OBJECTIVES: To provide an objective analysis of surgical performance of robotic-assisted laparoscopic hysterectomy (RALH) with lymphadenectomy for endometrial cancer during the learning phase of the procedure and to assess opportunities for improvement. METHODS: From July 2006 to March 2008, 100 patients with endometrial cancer underwent RALH with lymphadenectomy using the da Vinci Robotic Surgical System. Data were analyzed for operative time (OT), estimated blood loss (EBL), length of stay (LOS), intra-operative complications, surgical-pathologic factors, and post-operative complications using an intent-to-treat analysis. A comparison of the data on a quartile (Q) basis was performed for the 100 RALH cases and separately for the 65 cases that had a complete pelvic-and-aortic lymphadenectomy (PAL). RESULTS: Age and body mass index (BMI) did not change significantly during the study. More grade 3 tumors were treated in the last 50 cases (22% vs. 10%, p<0.05). Stage III tumors were identified in 18.7% cases in Q2-4 and none in Q1 (p<0.05). The number of patients undergoing complete PAL and the number of aortic lymph nodes (LN) removed per case increased each quarter. There were 4 (4%) conversions to laparotomy. Delayed vaginal cuff healing decreased from 16% in Q1 to 0% in Q3-4. No case required blood transfusion. Comparing first 10 cases to the last 10 cases, the total LN counts increased from 15 to 21 nodes, the aortic LN counts increased from 4.7 to 8.0, and the OT decreased from 203 to 160 min. Intra-surgeon analysis revealed an improvement in the total LN yields from first 50 to second 50 cases for each surgeon. CONCLUSIONS: Operative times decreased and aortic dissections improved with increasing LN counts during the first 100 cases of RALH. Furthermore, patient safety and improvement in surgical performance was demonstrated.




“Robot-assisted laparoscopy in gynoncologic surgery: what’s new?”

Lambaudie, E., J. Blanc, et al. (2009).

Actualités sur l’assistance robotisée en chirurgie oncogynécologique: 1-6.


Laparoscopic approach, over the past 20 years, has become, in gynoncologic surgery, a gold standard for several teams. Introduced 10 years ago, robotic-assisted laparoscopy is increasingly used in the gynecologic surgical field. For the surgeon, advantages of this intuitive robotic surgery are the three-dimensional approaches, the precision of the dissection with robotic instrument articulation, and a shorter learning curve compared with conventional laparoscopy. For the patients, a quicker postoperative recovery, less postoperative pain, and lower blood loss compared with laparoscopy seem to emerge. This review summarizes all the published results of robotic assistance used in cervical and endometrial cancer surgical management. © 2009 Springer Verlag France.




“Robotically-assisted laparoscopic anterior pelvic exenteration for recurrent cervical cancer: Report of three first cases.”

Lambaudie, E., F. Narducci, et al. (2009).

Gynecol Oncol.




“Meeting the challenge of developing and maintaining radical hysterectomy skills.”

Nevin, J., D. Luesley, et al. (2010).

BJOG: An International Journal of Obstetrics and Gynaecology 117(1): 1-4.




“Response to “A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy”.”

Nezhat, F., J. Cho, et al. (2009).

Gynecol Oncol.




“Safety and feasibility of robotic radical trachelectomy in patients with early-stage cervical cancer.”

Ramirez, P. T., K. M. Schmeler, et al. (2009).

Gynecol Oncol.


OBJECTIVE.: This study aimed to determine the safety and feasibility of robotic radical trachelectomy and bilateral pelvic lymphadenectomy. We also describe our surgical technique. METHODS.: This is a retrospective review of all patients who underwent robotic radical trachelectomy and bilateral pelvic lymphadenectomy from October 2008 to May 2009. We analyzed our data to evaluate the safety and feasibility of this surgery. RESULTS.: This analysis included 4 patients with early-stage squamous cell carcinoma of the cervix. The median body mass index was 27.1 kg/m(2) (range, 22.7 to 39.1). Three patients had stage IA2 adenocarcinoma; 1 patient had stage IA1 adenocarcinoma with lymph-vascular space invasion. The median operative time was 339.5 min (range, 245 to 416). The median console time was 282.5 min (range, 217 to 338). The median estimated blood loss was 62.5 ml (range, 50 to 75). There were no conversions to laparotomy. There were no intraoperative complications. No patient required blood transfusion. The median length of hospital stay was 1.5 days (range, 1 to 2). One patient experienced a postoperative complication, transient left lower extremity sensory neuropathy. No patient had residual tumor in the trachelectomy specimen, and no patient underwent adjuvant therapy. The median number of pelvic lymph nodes removed was 20 (range, 18 to 27). The median time to a successful voiding trial was 8 days (range, 7 to 9). The median follow-up was 105 days (range, 82 to 217). There were no recurrences. CONCLUSION.: Robotic radical trachelectomy and bilateral pelvic lymphadenectomy is feasible and safe and should be considered for patients desiring fertility-sparing surgery.




“Robotic radical hysterectomy: A literature review.”

Smith, A. L., R. Pareja, et al. (2009).

Minerva Ginecologica 61(4): 339-346.


Advanced laparoscopic procedures are increasingly being used as an alternative to laparotomy in gynecologic surgery. Several reviews have been completed that examine the advantages and drawbacks of this technique. Robotic technology offers the promise of overcoming many of the shortcomings of laparoscopy, while preserving classic operative techniques. This review article summarizes some of the most recent literature provided in the arena of robotic assisted radical hysterectomy for the treatment of cervical or endometrial cancer.




“Selected commentary to “Robot-assisted thoracoscopic oesophagectomy for cancer”.”

Wykypiel, H. and J. Bodner (2009).

European Surgery – Acta Chirurgica Austriaca 41(5): 241-244.




“Recent Advances in the Surgical Management of Cervical Cancer.”

Zakashansky, K., W. H. Bradley, et al. (2009).

Mt Sinai J Med 76(6): 567-576.


Recent advances in the surgical management of early cervical cancer, including abdominal, laparoscopic, vaginal, and robotic approaches to radical hysterectomy as well as fertility-sparing radical trachelectomy, are reviewed. The nerve-sparing abdominal radical hysterectomy technique allows for a significant reduction in postoperative bladder morbidity. Radical vaginal hysterectomy with laparoscopic lymph node dissection is a well-recognized technique that offers excellent cure rates without abdominal entry as well as reduced postoperative febrile and gastrointestinal morbidity. Total laparoscopic radical hysterectomy is a minimally invasive alternative to the traditional abdominal radical hysterectomy approach and yields a comparable safety profile with a significant reduction in blood loss and hospital stay. Robotic surgery is becoming more widely accepted in the management of gynecologic cancers, including radical hysterectomy for early cervical cancer. Young women desiring to bear children in the future may be candidates for fertility preservation options, and the radical trachelectomy operation has been described and performed with abdominal, vaginal, laparoscopic, and robotic techniques. There are a number of surgical options for the treatment of women with early cervical cancer. The feasibility and safety of some of these techniques have been well established, whereas for others, the oncological outcome data are only preliminary. The decision to use newer techniques should be directed by patient variables as well as the surgeon’s training and competence with laparoscopy, robotics, or vaginal surgery. Mt Sinai J Med 76:567-576, 2009. (c) 2009 Mount Sinai School of Medicine.




“Comparison of robotic and laparoscopic myomectomy.”

Bedient, C. E., J. F. Magrina, et al. (2009).

American Journal of Obstetrics and Gynecology 201(6).


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. © 2009 Mosby, Inc. All rights reserved.




“Robotically assisted laparoscopic microsurgical tubal reanastomosis: a retrospective study.”

Caillet, M., J. Vandromme, et al. (2009).

Fertil Steril.


OBJECTIVE: To evaluate the pregnancy and delivery outcome of robot-assisted tubal reanastomosis. DESIGN: Retrospective cohort study. SETTING: University hospital. PATIENT(S): Ninety-seven patients with available follow-up who underwent the reversal of tubal ligation, with a median age of 37 years (range, 24-47 years). INTERVENTION(S): Tubal reanastomosis by robot-assisted laparoscopy. MAIN OUTCOME MEASURE(S): Analysis of the distribution of time to conception and to estimate the crude pregnancy and birth rates at 2 years. RESULT(S): The overall pregnancy and birth rates were 71%, (95% confidence interval [CI], 61%-80%) and 62% (95% CI, 52%-72%). Ninety-one percent (95% CI, 76%-98%) of patients <35 years old became pregnant, and 88% (95% CI, 72%-97%) delivered at least once. The corresponding pregnancy and delivery rates were 75% (95% CI, 57%-89%) and 66% (95% CI, 47%-81%) between 36 and 39 years old, 50% (95% CI, 25%-75%) and 43.8% (95% CI, 20%-70%) between 40 and 42 years old, 33% (95% CI, 10%-65%) and 8.3% (95% CI, <1%-38%) after the age of 43 years. CONCLUSION(S): This study reports satisfactory birth rates after tubal reanastomosis by robot-assisted laparoscopy in patients aged 40 years or less.




“Laparoscopy in pregnancy: A literature review.”

Chohan, L. and C. C. Kilpatrick (2009).

Clinical Obstetrics and Gynecology 52(4): 557-569.


The first laparoscopic surgery in pregnancy was a cholecystectomy in 1991. Since that time, a number of articles and case series have been published addressing laparoscopy in pregnancy. Current recommendations are on the basis of these findings, such as operating during any trimester in pregnancy can be safely performed, fetal heart monitoring should be made preoperatively and postoperatively, prophylactic tocolytics should not be used, and multiple entry techniques (Veress needle, Hasson trocar, or optical trocar) can be safely performed. This article will review anesthesia, fetal effects, obesity, complications, adnexal masses, and gastrointestinal issues. © 2009, Lippincott Williams & Wilkins.




“Discussion: ‘Comparison of robotic and laparoscopic myomectomy’ by Bedient et al.”

Cooper, A. R., M. A. Powell, et al. (2009).

Am J Obstet Gynecol 201(6): e1-4.




“Abdominal, Laparoscopic, and Robotic Surgery for Pelvic Organ Prolapse.”

McDermott, C. D. and D. S. Hale (2009).

Obstetrics and Gynecology Clinics of North America 36(3): 585-614.


Abdominal correction of pelvic organ prolapse remains a viable option for patients and surgeons. The transition from open procedures to less invasive laparoscopic and robotic-assisted surgeries is evident in the literature. This article reviews the surgical options available for pelvic organ prolapse repair and their reported outcomes. Procedures reviewed include apical support (sacral, uterosacral, and others), and abdominal anterior and posterior vaginal wall support. Long-term follow-up and appropriately designed studies will further help direct surgeons in deciding which approach to incorporate into their practice. © 2009 Elsevier Inc. All rights reserved.



“Role of robotic surgery in urogynecologic surgery.”

Moy, M. L. and S. Y. Byun (2010).

Curr Opin Urol 20(1): 70-74.


PURPOSE OF REVIEW: Robotic surgery with its numerous advantages over conventional laparoscopy has assumed an ever-expanding role in pelvic and pelvic floor reconstructive surgery. Our goal is to review the literature regarding robotic use in urogynecologic surgery. RECENT FINDINGS: The current literature demonstrates the feasibility and safety of performing robotic urogynecologic procedures in a wide variety of cases. Robotic sacrocolpopexy and hysterectomy are most commonly described, but the use of robotics in the repair of complex pelvic fistulae has also been examined. The available studies mainly consist of case series with short-term follow-up, but early outcomes appear to be comparable to open surgery with decreased patient morbidity. SUMMARY: The role of robotics in urogynecologic surgery will continue to grow, as there is an increasing access to the robotic platform, and its use is being incorporated into residency training. More robust studies will be needed to validate the continued use of the robot, as there are concerns regarding cost, training, and credentialing.




Smith, A. L. and S. Raz (2009).

BJU Int.