“Choosing the route of hysterectomy for benign disease.” (2009).
Obstetrics and Gynecology 114(5): 1156-1158.
Hysterectomies are performed vaginally, abdominally, or with laparoscopic or robotic assistance. When choosing the route and method of hysterectomy, the physician should take into consideration how the procedure may be performed most safely and cost-effectively to fulfill the medical needs of the patient. Evidence demonstrates that, in general, vaginal hysterectomy is associated with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy. When it is not feasible to perform a vaginal hysterectomy, the surgeon must choose between laparoscopic hysterectomy, robot-assisted hysterectomy, or abdominal hysterectomy. Experience with robot-assisted hysterectomy is limited at this time; more data are necessary to determine its role in the performance of hysterectomy. The decision to electively perform a salpingoophorectomy should not be influenced by the chosen route of hysterectomy and is not a contraindication to performing a vaginal hysterectomy.
“Robot-assisted staging using three robotic arms for endometrial cancer: comparison to laparoscopy and laparotomy at a single institution.”
Jung, Y. W., D. W. Lee, et al. (2010).
J Surg Oncol 101(2): 116-121.
PURPOSE: To demonstrate the feasibility of robot-assisted staging surgery using three arms in patients with endometrial cancer. METHODS: One hundred nine patients with clinical stage I endometrial cancer who underwent staging surgery at Yonsei University Health System were enrolled from May 2006 to January 2009. Patient demographics and operative outcomes were prospectively collected. RESULTS: Robotic surgery using three arms was performed in 28 patients, laparoscopy in 25, and laparotomy in 56. There were no differences among the three groups in terms of patient demographics. The number of harvested pelvic lymph nodes was lower in the laparoscopy group than in the laparotomy group (18.36 +/- 7.25 vs. 24.39 +/- 10.08, respectively, P = 0.025), but there was no difference between the robot and laparotomy groups. The number of resected para-aortic lymph nodes and operative time did not differ among the three groups. The average hospital stay was longer for the laparotomy group than the robot and laparoscopy groups (10.78 days vs. 7.92 days vs. 7.67 days, respectively, P < 0.001). Operative complications and transfusions developed more frequently in the laparotomy group than in the robot and laparoscopy groups (25.0% vs. 7.1% vs. 8.0%, respectively, P = 0.049; 42.9% vs. 14.3% vs. 16.0%, respectively, P = 0.006). CONCLUSION: Robot-assisted surgery using three arms is a feasible method for surgical staging in patients with clinical stage I endometrial cancer.
“Role of robot-assisted laparoscopy in adjuvant surgery for locally advanced cervical cancer.”
Lambaudie, E., F. Narducci, et al. (2010).
Eur J Surg Oncol.
OBJECTIVE: The aim of this study was to compare the feasibility and efficacy of robot-assisted laparoscopy with traditional laparotomy and conventional laparoscopy in a series of patients with locally advanced cervical cancer managed in our two institutions. METHODS: Twenty-two patients who underwent robot-assisted laparoscopy were compared with 20 patients who underwent adjuvant surgery by laparotomy and 16 who underwent conventional laparoscopy, before the arrival of the Da Vinci surgical system. RESULTS: There was no significant difference between the three groups in terms of body mass index, FIGO stage, or tumor histology. The complication rate was similar in the three groups of patients, although there was a trend towards more lymphatic complications in the robot-assisted subgroup managed medically. There was no significant difference in the recurrence rate between the robot-assisted laparoscopy, conventional laparoscopy and laparotomy groups (27.3%, 29.4% and 30%, respectively). CONCLUSION: Robot-assisted laparoscopy is feasible after concurrent chemoradiation and brachytherapy in cases of locally advanced cervical cancer. This new surgical approach reduces hospital stay, and seems to result in less severe complications than conventional laparotomy without modifying the oncological outcome.
“Robotic transperitoneal infrarenal aortic lymphadenectomy technique and results.”
Magrina, J. F., J. B. Long, et al. (2010).
International Journal of Gynecological Cancer 20(1): 184-187.
Introduction: This study was designed to evaluate the feasibility and the results of robotic transperitoneal infrarenal aortic lymphadenectomy. Methods: Development of a technique of robotic transperitoneal infrarenal aortic lymphadenectomy in female cadavers and review of the results in 33 patients who underwent the newly developed technique as part of the surgical treatment of gynecologic malignancies. Results: The mean console time was 42 minutes (range, 19-64 minutes). The mean number of nodes was 12.9 (range, 2-27); the mean number of positive nodes was 2.6 (range, 0-8). There was 1 conversion to laparotomy. Conclusions: Robotic transperitoneal infrarenal aortic lymphadenectomy can be performed adequately and safely with the robotic column at the patient’s head. Operating table rotation and additional trocar sites are needed when used in conjunction with robotic pelvic surgery. Copyright © 2010 by IGCS and ESGO.
“Robotic port-site and pelvic recurrences after robot-assisted laparoscopic radical hysterectomy for a stage IB1 adenocarcinoma of the cervix with negative lymph nodes.”
Sert, B. (2010).
Int J Med Robot.
BACKGROUND: Port-site metastasis (PSM) following minimally invasive surgery for gynaecological cancer has been recognized as a potential problem over the last two decades. METHODS: A 60 year-old woman with stage Ib1 adenocarcinoma of the cervix was treated with radical hysterectomy, bilateral salpingo-oophorectomy and bilateral pelvic lymph node dissection, using robot-assisted laparoscopy. RESULTS: Eighteen months after primary surgery, the patient developed a pelvic recurrence invading both the bladder mucosa and the parametrium. During the routine recurrence work-up, we found an 8 mm robotic port-site metastasis (PSM) on the abdominal computed tomography (CT) scan. CONCLUSION: This is the first case report emphasizing the risk of PSM and early pelvic recurrences in robot-assisted laparoscopic radical hysterectomy and bilateral pelvic lymph node dissection for an early-stage cervical adenocarcinoma patient with negative lymph nodes, histologically examined by immunohistochemical ultrastaging. Copyright (c) 2009 John Wiley & Sons, Ltd.
“ACOG technology assessment No. 6: Robot-assisted surgery.” (2009).
Obstetrics and Gynecology 114(5): 1153-1155.
The field of robotic surgery is developing rapidly, but experience with this technology is currently limited. In response to increasing interest in robotics technology, the Committee on Gynecologic Practice’s Technology Assessment was developed to describe the robotic surgical system, potential advantages and disadvantages, gynecologic applications, and the current state of the evidence. Randomized trials comparing robot-assisted surgery with traditional laparoscopic, vaginal, or abdominal surgery are needed to evaluate long-term clinical outcomes and cost-effectiveness, as well as to identify the best applications of this technology. Copyright © November 2009 by the American College of Obstetricians and Gynecologists. All rights reserved.