Abstrakt Gynekologie Říjen 2009

“Robotic-assisted sacrocolpopexy: technique and learning curve.”

Akl, M. N., J. B. Long, et al. (2009).

Surg Endosc 23(10): 2390-2394.


BACKGROUND: Laparoscopic sacrocolpopexy (LSCP) offers a minimally invasive approach for treating vaginal vault prolapse. The Da Vinci robotic surgical system may decrease the difficulty of the procedure. The objective of this study was to describe the surgical technique of robotic-assisted sacrocolpopexy (RASCP) and evaluate its feasibility, safety, learning curve, and perioperative complications. METHODS: Eighty patients underwent RASCP between November 2004 and June 2007. Robotic dissection of the planes between the bladder and vagina anteriorly and between the vagina and rectum posteriorly was performed. A peritoneal incision was made to expose the sacral promontory and extended down to the vaginal apex. A Y-shaped mesh was sutured to the anterior and posterior surfaces of the vagina. The tail end of the mesh was sutured to the sacral promontory. Intracorporeal knot tying was used in all sutures. The peritoneal incision was closed to cover the mesh using a running suture. RESULTS: Mean operative time was 197.9 [standard deviation (SD) 66.8] min. After completion of the first ten cases, mean operative time decreased by 25.4% [64.3 min, 95% confidence interval (CI) 16.1-112.4 min, p < 0.01]. Two (2.5%) patients had injury to the bladder, one (1.2%) patient had a small bowel injury, and one (1.2%) patient had a ureteric injury. Postoperatively, five (6%) patients developed vaginal mesh erosion, one (1.2%) patient developed a pelvic abscess, and one (1.2%) patient had postoperative ileus. Four (5%) cases were converted to laparotomy. Mean follow-up period was 4.8 months (range 1-24 months). CONCLUSIONS: RASCP is a feasible procedure with acceptable complication rates and short learning curve.




“Turkey’s experience of robotic-assisted laparoscopic hysterectomy: a series of 25 consecutive cases.”Gocmen, A., F. Sanlikan, et al. (2009).

Arch Gynecol Obstet.


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.




“Comparison of a novel surgical approach for radical hysterectomy: robotic assistance versus open surgery.”

Feuer, G., B. Benigno, et al. (2009).

Journal of Robotic Surgery: 1-8.


To report the learning curve and perioperative outcomes for robotic radical hysterectomy using a unilateral surgical approach transferred directly from one surgeon’s open radical hysterectomy experience, thirty-two consecutive robotic radical hysterectomy cases (10/2006-1/2009) were contrasted to a cohort of 20 consecutive open radical hysterectomies (2/2005-2/2008). Perioperative characteristics compared included operative time, number of nodes, estimated blood loss, length of hospital stay, and complications. Robotic operative times were significantly longer than for open (122.1 ± 33.0 versus 67.5 ± 16.2 min, P < 0.0001), but decreased with experience, going from 156.0 min for the first eight robotic cases to 95.0 min for the last eight cases (P < 0.05). Blood loss (99.2 ± 46.2 mL versus 275.0 ± 206.0 mL, P < 0.0001) and length of hospital stay (1.7 versus 5.2 days, P < 0.001) were significantly lower for the robotic cohort. Lymph node yield in the robotic cohort was equivalent to that for the open cohort (11.5 versus 9.2, P = 0.1446), and complication rates were 21.9% for robotic and 30.0% for open radical hysterectomy. Implementing a unilateral approach to maximize surgical efficiency greatly reduced surgical times without compromising patient morbidity, bringing robotic operative times while still within the learning curve close to those for open radical hysterectomy. Thus, robotic radical hysterectomy may soon be considered the preferred standard front-line therapy for cervical cancer. © 2009 Springer-Verlag London Ltd.




“Quality assurance for radical hysterectomy for cervical cancer: The view of the European Organization for Research and Treatment of Cancer – Gynecological Cancer Group (EORTC-GCG).”

Verleye, L., I. Vergote, et al. (2009).

Annals of Oncology 20(10): 1631-1638.


Radical hysterectomy combined with a pelvic lymphadenectomy or chemoradiation are traditionally the mainstays of treatment of International Federation of Gynecology and Obstetrics stages Ia2-IIa cervical cancer. The quality of radical surgery for cervical cancer influences local tumor control and survival. Hence, it is important to optimize and ensure the quality of surgical care for cervical cancer patients. In this paper, we discuss factors that are related to outcome after radical hysterectomy and propose a set of quality indicators that can be used to audit and improve the quality of surgical care for cervical cancer patients. © The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.




“Recent advances of robotic surgery and single port laparoscopy in gynecologic oncology.”

Jung, Y. W., S. W. Kim, et al. (2009).

J Gynecol Oncol 20(3): 137-144.


Two innovative approaches in minimally invasive surgery that have been introduced recently are the da Vinci robotic platform and single port laparoscopic surgery (SPLS). Robotic surgery has many advantages such as 3-dimensional view, the wrist like motion of the robotic arm and ergonomically comfortable position for the surgeon. Numerous literatures have demonstrated the feasibility of robotic surgery in gynecologic oncology. However, further research should be performed to demonstrate the superiority of robotic surgery compared to conventional laparoscopy. Additionally, cost reduction of robotic surgery is needed to adopt robotic surgery into gynecologic oncology worldwide. SPLS has several possible benefits including reduced operative complications, reduced postoperative pain, and better cosmetic results compared to conventional laparoscopy. Although several authors have indicated that SPLS is a feasible approach for gynecologic surgery, there have been few reports demonstrating the potential advantages over conventional laparoscopy. Moreover, technical difficulties of SPLS still exist. Therefore, the advantages of a single port approach compared to conventional laparoscope should be evaluated with comparative study, and further technologic development for SPLS is also needed. These two progressive technologies take the lead in the development of MIS and further studies should be performed to evaluate the benefits of robot surgery and SPLS.



“Robotic assisted total pelvic exenteration: A case report.”

Lim, P. C. W. (2009).

Gynecologic Oncology 115(2): 310-311.