Robotic-assisted laparoscopy in gynecological surgery

Camran Nezhat, Naghmeh S Saberi, Babac Shahmohamady, Farr Nezhat, Camran Nezhat, Naghmeh S Saberi, Babac Shahmohamady, Farr Nezhat

Abstract

Background: Laparoscopic surgery has revolutionized the concept of minimally invasive surgery for the last 3 decades. Robotic-assisted surgery is one of the latest innovations in the field of minimally invasive surgery. Already, many procedures have been performed in urology, cardiac surgery, and general surgery. In this article, we attempt to report our preliminary experience with robotic-assisted laparoscopy in a variety of gynecological surgeries. We sought to evaluate the role of robotic-assisted laparoscopy in gynecological surgeries.

Methods: The study was a case series of 15 patients who underwent various gynecologic surgeries for combined laparoscopic and robotic-assisted laparoscopic surgery. The da Vinci robot was used in each case at a tertiary referral center for laparoscopic gynecologic surgery. An umbilicus, suprapubic, and 2 lateral ports were inserted. These surgeries were performed both using laparoscopic and robotic-assisted laparoscopic techniques. The assembly and disassembly time to switch from laparoscopy to robotic-assisted surgery was measured. Subjective advantages and disadvantages of using robotic-assisted laparoscopy in gynecological surgeries were evaluated.

Results: Fifteen patients underwent a variety of gynecologic surgeries, such as myomectomies, treatment of endometriosis, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy, and Moskowitz procedure. The assembly time to switch from laparoscopy to robotic-assisted surgery was 18.9 minutes (range, 14 to 27), and the disassembly time was 2.1 minutes (range, 1 to 3). Robotic-assisted laparoscopy acts as a bridge between laparoscopy and laparotomy but has the disadvantage of being costly and bulky.

Conclusion: Robotic-assisted laparoscopic surgeries have advantages in providing a 3-dimensional visualization of the operative field, decreasing fatigue and tension tremor of the surgeon, and added wrist motion for improved dexterity and greater surgical precision. The disadvantages include enormous cost and added operating time for assembly and disassembly and the bulkiness of the equipment.

References

    1. Nezhat Camran, Siegler Alvin, Nezhat Farr, Nezhat Ceana, Seidman Daniel, Luciano Anthony. Operative Gynecologic Laparoscopy; Principles and Techniques. Second Edition. New York: McGraw Hill; 2000
    1. Binder Jochen, Brautigam Ronald, Jonas Dietger, Bentas Wassilios. Robot surgery in urology: Fact or fancy? BJU Int. 2002; 94: 1183–1187
    1. Falcone T, Goldberg J, Garcia-Ruiz A, Margossian H, Stevens L. Full robotic assistance for laparoscopic tubal anastomosis: a case report. J Laparoendosc Adv Surg Tech A. 1999; 9: 107–113
    1. Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C., Jr Laparoscopic hysterectomy using a computer-enhanded surgical robot. Surg Endosc. 2002; 16: 1271–1273
    1. Advincula AP, Song A, Burke W, Reynolds RK. Preliminary experience with robot-sssisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 2004; 11 (4): 511–518
    1. DiMarco DS, Chow GK, Gettman MT, Ellieott Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. Urology. 2004; 63 (2): 373–376
    1. Ferguson JL, Beste TM, Nelson KH, Daucher JA. Making the transition from the standard gynecologic laparoscopy to robotic laparoscopy. JSLS. 2004; 8: 326–328

Source: PubMed

3
購読する