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Gruhl SL, Yusoff MA, Chin HMS, Nadarajah R. An eight-year analysis of robotic surgery in morbidly obese women with endometrial cancer in a tertiary center in Singapore. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100330. [PMID: 39188906 PMCID: PMC11347051 DOI: 10.1016/j.eurox.2024.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/24/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Introduction Surgical management of endometrial cancer is a total hysterectomy, bilateral salphingo-oophorectomy and pelvic lymph node dissection (THBSO-PLND), which is a challenging surgery in the morbidly obese. Data on morbidly obese women undergoing robotic surgery is limited in Asia. We share our experience in Singapore and aim to demonstrate that robotic surgery is safe and effective in morbidly obese women with endometrial cancer. Materials and Methods We performed a retrospective analysis of patients with BMI > 40 kg/m2, who underwent robotic surgery from January 2016 to September 2023 at the Singapore General Hospital. We recruited a total of 33 patients who underwent robotic surgery for endometrial malignancy and analysed surgical outcomes, operative complications, and survival rates. Results The average age of patients was 53 years and mean BMI 45.7. The average operative time was 232 min and average blood loss 184 ml. 3 patients had THBSO while 27 underwent THBSO-PLND. None required conversion to laparotomy. 4 patients required a mini-laparotomy for the retrieval of bulky uterus. 12 required adhesiolysis. 6 patients had additional omentectomy done. The average inpatient stay was 4.8 days. The 1-year mortality rate is 0. However, 1 patient passed away 13 months after surgery due to complications from bowel obstruction and another passed away 39 months later due to disease recurrence. 1 patient readmitted on POD6 due to post-op ileus and another for port-site hematoma. Both were managed conservatively. Conclusion Robotic surgery is a safe and effective alternative surgical tool for women who are morbidly obese with endometrial cancer.
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Affiliation(s)
- Sabrina Lasini Gruhl
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Muhammad Ashraf Yusoff
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Hui Men Selina Chin
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Ravichandran Nadarajah
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
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Xie S, Wood TC, Dasgupta P, Aydin A. Robot Assisted Laparoscopic Surgery in Gynaecology: An Evolving Assistive Technology. Surg Innov 2024; 31:324-330. [PMID: 38446503 PMCID: PMC11047015 DOI: 10.1177/15533506241238038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Laparoscopic surgery is extensively utilized to treat a range of gynaecological conditions and pathologies. The advantages of laparoscopic surgery include the minimalization of blood loss and scarring, improved recovery times, and shorter hospital admissions. However, robotic technologies have had an increasing presence within gynaecological laparoscopic surgery in recent decades. This literature review therefore aims to discuss laparoscopy from 3 perspectives. First, the evolution of laparoscopy is reviewed with a focus on its origins, its transition from a diagnostic to an operative tool, and its role in present-day gynaecology. Second, interventions for benign gynaecological conditions (including excision of benign ovarian tumours, total laparoscopic hysterectomy, and laparoscopic myomectomy) are reviewed. The laparoscopic management of malignant gynaecology (including ovarian cancer, endometrial cancer, and cervical cancer) is also discussed. Finally, whilst robot-assisted laparoscopic surgery is experiencing rapid technological advancement, it is pertinent to consider the extent of its benefits when compared to open or conventional laparoscopic approaches in gynaecological surgery.
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Affiliation(s)
- Siwen Xie
- Department of Surgical & Intervention Engineering, King’s College London, London, UK
| | - Thomas Charles Wood
- Department of Obstetrics and Gynaecology, The Hillingdon Hospital, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King’s College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King’s College London, London, UK
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Alkatout I, Becker T, Nuhn P, Pochhammer J, Peters G, Donald KM, Mettler L, Ackermann J. The first robotic-assisted hysterectomy below the bikini line with the Dexter robotic system™. Facts Views Vis Obgyn 2024; 16:87-91. [PMID: 38551479 PMCID: PMC11198885 DOI: 10.52054/fvvo.16.1.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Background Robotic-assisted hysterectomy (RAH) is a widely accepted minimally invasive approach for uterus removal. However, as RAH is typically performed in the umbilical region, it usually results in scars in cosmetically suboptimal locations. This is the first case of RAH with cervicosacropexy performed below the bikini line, using the new Dexter robotic system™. Objectives The aim of this article is to show the surgical steps of the first RAH with cervicosacropexy performed below the bikini line with the new Dexter robotic system™ (Distalmotion), and furthermore assess the feasibility of this approach using this robotic platform. Materials and Methods A 43-year-old woman with uterine adenomyosis and recurrent uterine prolapse underwent a robotic-assisted subtotal hysterectomy with cervicosacropexy, performed below the bikini line, using the Dexter robotic system™, at the Clinic of Gynecology and Obstetrics at Universitätsklinikum Schleswig-Holstein (UKHS) in Kiel, Germany. Main outcome measures Perioperative data, surgical approach specifics, objective, and subjective outcomes of this new approach. Results The procedure was performed without intra-operative complications; estimated blood loss was 10 ml. Operative time was 150 minutes, console time 120 minutes, total docking time 6 minutes. Dexter performed as expected; no device-related issues or robotic arm collisions occurred. The patient did not require pain medication and was released on the second postoperative day. Conclusion RAH performed below the bikini line using the Dexter robotic system™ is a feasible, safe, and adequate procedure. These initial results should be confirmed and further extensively refurbished with larger patient cohorts, and functional and psychological outcomes need further investigation.
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Alkatout I, O’Sullivan O, Peters G, Maass N. Expanding Robotic-Assisted Surgery in Gynecology Using the Potential of an Advanced Robotic System. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:53. [PMID: 38256313 PMCID: PMC10818539 DOI: 10.3390/medicina60010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Minimally invasive surgery (MIS) in gynecology was introduced to achieve the same surgical objectives as traditional open surgery while minimizing trauma to surrounding tissues, reducing pain, accelerating recovery, and improving overall patient outcomes. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, have become the standard for many gynecological procedures. In this review, we aim to summarize the advantages and main limitations to a broader adoption of robotic-assisted surgery compared to laparoscopic surgeries in gynecology. We present a new surgical system, the Dexter Robotic System™ (Distalmotion, Switzerland), that facilitates the transition from laparoscopy expertise to robotic-assisted surgery.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany
| | - Odile O’Sullivan
- Distalmotion SA, Route de la Corniche 3b, 1066 Epalinges, Switzerland;
| | - Göntje Peters
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany
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Mothes AR, Kather A, Cepraga I, Esber A, Kwetkat A, Runnebaum IB. Robotic-assisted Gynecological Surgery in Older Patients - a Comparative Cohort Study of Perioperative Outcomes. Geburtshilfe Frauenheilkd 2023; 83:437-445. [PMID: 37153652 PMCID: PMC10155232 DOI: 10.1055/a-1902-4577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 05/10/2023] Open
Abstract
Study design Because of current demographic developments, a hypothesis was proposed whereby older female patients aged > 65 years can be safely operated using minimally invasive, robotic-assisted surgery, despite having more preoperative comorbidities. A comparative cohort study was designed to compare the age group ≥ 65 years (older age group, OAG) with the age group < 65 years (younger age group, YAG) after robotic-assisted gynecological surgery (RAS) in two German centers. Patients and methods Consecutive RAS procedures performed between 2016 and 2021 at the Women's University Hospital of Jena and the Robotic Center Eisenach to treat benign or oncological indications were included in the study. The age groups were compared according to their preoperative comorbidities (ASA, Charlson comorbidity index [CCI], cumulative illness rating scale - geriatric version [CIRS-G]) and perioperative parameters such as Clavien-Dindo (CD) classification of surgical complications. Analysis was performed using Welch's t -test, chi 2 test, and Fisher's exact test. Results A total of 242 datasets were identified, of which 63 (73 ± 5 years) were OAG and 179 were YAG (48 ± 10 years). Patient characteristics and the percentage of benign or oncological indications did not differ between the two age groups. Comorbidity scores and the percentage of obese patients were higher in the OAG group: CCI (2.7 ± 2.0 vs. 1.5 ± 1.3; p < 0.001), CIRS-G (9.7 ± 3.9 vs. 5.4 ± 2.9; p < 0.001), ASA class II/III (91.8% vs. 74.1%; p = 0.004), obesity (54.1% vs. 38.2%; p = 0.030). There was no difference between age groups, even grouped for benign or oncological indications, with regard to perioperative parameters such as duration of surgery (p = 0.088; p = 0.368), length of hospital stay (p = 0.786; p = 0.814), decrease in Hb levels (p = 0.811; p = 0.058), conversion rate (p = 1.000; p = 1.000) and CD complications (p = 0.433; p = 0.745). Conclusion Although preoperative comorbidity was higher in the group of older female patients, no differences were found between age groups with regard to perioperative outcomes following robotic-assisted gynecological surgery. Patient age is not a contraindication for robotic gynecological surgery.
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Affiliation(s)
- Anke R. Mothes
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
| | - Angela Kather
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Irina Cepraga
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Anke Esber
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Anja Kwetkat
- Klinik für Geriatrie und Palliativmedizin, Klinikum Osnabrück GmbH, Osnabrück, Germany
| | - Ingo B. Runnebaum
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
- Correspondence Prof. Dr. Ingo B. Runnebaum, MBA Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin,
Universitätsklinikum JenaAm Klinikum 107747
JenaGermany
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Lee YJ, Lee DE, Oh HR, Ha HI, Lim MC. Learning curve analysis of multiport robot-assisted hysterectomy. Arch Gynecol Obstet 2022; 306:1555-1561. [PMID: 35767099 DOI: 10.1007/s00404-022-06655-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the surgical outcomes and learning curve of multiport robot-assisted hysterectomy. METHODS Eighty-eight patients were identified who underwent multiport robot-assisted surgery for hysterectomy. A retrospective analysis was performed. The cumulative summation technique (CUSUM) was used to investigate the learning curve in surgical proficiency by analyzing total operative, docking, and console times. RESULTS The patients' median age was 51 years. In addition, the median operative time was 120.5 min (range 56-344 min). The most common indication for surgery was myoma (33.0%). The median estimated blood loss was 30 mL (range 5-200 mL). There was no conversion to laparoscopic or open surgery. No transfusion was required, and only one complication including umbilical incisional hernia was reported. A tendency of decline in total operative time following the first 23 cases was found. The CUSUM graph for total operative time indicated the generation of three distinct performance phases: learning (n = 23), competence (n = 36), and mastery (n = 29). The median docking time was 3 min (range 1-10 min) and median console time was 70 min (range 24-298 min). CONCLUSION The multiport robot-assisted surgery is an easy and safe procedure with minimal postoperative complications and can be quickly learned. The learning curve was 23 cases to significantly decrease the operative time.
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Affiliation(s)
- Yeon Jee Lee
- Center for Gynecologic Cancer, National Cancer Center, Research Institute and Hospital, Goyang, South Korea
| | - Dong-Eun Lee
- National Cancer Center, Biostatistics Collaboration Team, Research Institute, Goyang, South Korea
| | - Hye Rim Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, Research Institute and Hospital, Goyang, South Korea.
- Rare and Pediatric Cancer Branch and Immuno-Oncology Branch, Division of Rare and Refractory Cancer, Research Institute and Center for Clinical Trial, Hospital, National Cancer Center, Goyang, South Korea.
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.
- National Cancer Center, Center for Gynecologic Cancer and Division of Rare and Refractory Cancer, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
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