1
|
Appelbaum H. Perioperative and Operative Considerations for Minimally Invasive Surgery in Pediatric and Adolescent Gynecology. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00261-4. [PMID: 39098547 DOI: 10.1016/j.jpag.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 07/07/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
Minimally invasive surgery (MIS) techniques, including vaginoscopy, laparoscopy and robotic-assisted surgery (RAS), have revolutionized the field of gynecology, offering numerous benefits such as reduced postoperative pain, shorter hospital stays, and faster recovery. While these techniques are widely employed in adult gynecologic surgery, their application in pediatric and adolescent patients requires careful consideration due to anatomical differences, patient size, and specific surgical requirements in children. Various aspects of MIS in pediatric and adolescent gynecology, including patient positioning, laparoscopic and robotic instrument choices, trocar placement, surgical techniques, and perioperative pediatric adaptations to MIS are discussed. The findings highlight the unique challenges and opportunities in performing MIS for pediatric and adolescent patients undergoing gyn surgery, emphasizing the need for specialized training and multidisciplinary collaboration.
Collapse
Affiliation(s)
- Heather Appelbaum
- Associate Professor, Obstetrics and Gynecology, Hackensack School of Medicine, Chief, Division of Pediatric and Adolescent Gynecology; K. Hovnanian Children's Hospital at Jersey Shore University Medical Center
| |
Collapse
|
2
|
Buote NJ. Looking to the Future; Veterinary Robotic Surgery. Vet Clin North Am Small Anim Pract 2024; 54:735-751. [PMID: 38538406 DOI: 10.1016/j.cvsm.2024.02.008] [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: 05/25/2024]
Abstract
This article details the rise of surgical robots in the human surgical sphere as well as their use in veterinary medicine. Sections will describe in detail the equipment required for these procedures and the advantages and disadvantages of their use. Specific attention is given to the articulated instrumentation, which affords psychomotor benefits not only for surgical precision but also for surgeon ergonomics. A discussion of the possible indications and current use of robotics in veterinary medicine and the challenges to integrating robotics is also provided.
Collapse
Affiliation(s)
- Nicole J Buote
- Minimally Invasive Surgery (Soft Tissue), Cornell University College of Veterinary Medicine, Small Animal Surgery, 930 Campus Road, Ithaca, NY 14853, USA.
| |
Collapse
|
3
|
Pordal A, Guerra JD, Morin D, Oppat W, Jacobs MJ, Patil S. Temporal and institutional trends in robotic surgery. J Robot Surg 2024; 18:191. [PMID: 38693330 DOI: 10.1007/s11701-024-01914-w] [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] [Received: 02/07/2023] [Accepted: 05/21/2023] [Indexed: 05/03/2024]
Abstract
Robotic surgery has become increasingly prevalent in general surgery practice. While previous studies have shown the safety and efficacy of robotic assistance in laparoscopic general surgery procedures, few studies have evaluated the temporal and regional trends in implementation. In our retrospective population-based study, we aim to evaluate the national trends in robotic surgery. National Inpatient Database (NIS 2009-2014) was used to identify adults who underwent robotic assisted surgery (ICD 9 codes 17.41 to 17.49). Robotic procedures related to seven abdominal organ systems were compared against the trends of Urology, Gynaecologic, and Orthopedic robotic procedures. Discharge weights were applied to calculate National temporal trends separated by hospital size, teaching status and US geographic region. 894,163 patients received a robotic assisted procedure between 2009 and 2014 with 64% increase in utilization. The largest percent change was witnessed in biliary robotic procedures with 2984% change in utilization, followed by hernia (1376%). Lowest percent change was witnessed in esophageal procedures with 114% increase. Medium sized hospitals had the largest change in robotic utilization (41%), with large institutions seeing 18% decrease. Gastric procedures were the most common robotic procedure performed at small institutions (7917 total cases; 316%). Large institutions saw an overall decrease in gastric (- 47%), esophageal (- 17%), small and large intestinal (-16%), and hepatic (- 7%) robotic procedures. Rural non-teaching hospitals saw the largest increase in robotic surgery (274%). Urban non-teaching hospitals saw a decrease of 29%. While urban teaching institutions saw a 20% and 6% increase in gynecological and urological procedures, an overall decrease was seen in esophageal (- 10%), gastric (- 12%), intestinal (- 11%), hepatic (- 17%), biliary (- 10%), pancreatic (- 11%) and hernia procedures (- 14%). Biliary procedures saw the largest increase in rural institutions (740 cases; 392%), followed by hernia (144% increase). South region of the nation had the largest increase in robotic procedures (23%). No change was seen in the use of robotic surgery in the northeast region with the midwest and west seeing an overall decrease (- 4% and - 22%, respectively). Our study highlights the increase in use of robotics for both general and specialty surgery, with an increase in utilization over time. Increased incidence of robotic surgery in smaller, rural institutions with overall decrease in larger, urban teaching hospitals suggests increasing comfort in robotic surgery in the community setting. Further studies are necessary to evaluate the factors associated with increased utilization in smaller institutions.
Collapse
Affiliation(s)
- A Pordal
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - J D Guerra
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - D Morin
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - W Oppat
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - M J Jacobs
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA
| | - S Patil
- General Surgery Program, Department of Surgery, Ascension Providence Hospital, 22250 Providence Dr, Suite # 206, Southfield, MI, 48075, USA.
| |
Collapse
|
4
|
Lee N, Choi SH, Won S, Jung YW, Kim SH, Lee JY, Lim CK, Yang JB, Ha JG, Seong SJ. Comparison of Surgical Outcomes of Two New Techniques Complementing Robotic Single-Site Myomectomy: Coaxial Robotic Single-Site Myomectomy vs. Hybrid Robotic Single-Site Myomectomy. J Pers Med 2024; 14:439. [PMID: 38673066 PMCID: PMC11050827 DOI: 10.3390/jpm14040439] [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: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This study aimed to compare surgical outcomes between two new robotic single-site myomectomy (RSSM)-complementary techniques: coaxial robotic single-site myomectomy (Coaxial-RSSM) and hybrid robotic single-site myomectomy (Hybrid-RSSM). METHODS Medical records for 132 women undergoing Coaxial-RSSM and 150 undergoing Hybrid-RSSM, consecutively, were retrospectively reviewed. Patient characteristics and surgical outcomes were assessed and compared after propensity score matching (PSM). RESULTS In the outcomes of PSM, the Coaxial-RSSM group showed significantly reduced blood loss (79.71 vs. 163.75 mL, p < 0.001) and reduced hospital duration (4.18 ± 0.62 vs. 4.63 ± 0.90) relative to the Hybrid-RSSM group. Conversely, Hybrid-RSSM allowed for a shorter operative time compared with Coaxial-RSSM (119.19 vs. 156.01 min, p = 0.007). No conversions to conventional laparoscopy or laparotomy or any need for the multi-site robotic approach occurred in either group. Postoperative complications, including ileus, fever, and wound dehiscence, showed no statistically significant differences between the two groups. CONCLUSIONS Blood loss was lower with Coaxial-RSSM, and operative time was shorter for Hybrid-RSSM. A follow-up prospective study is warranted for more comprehensive comparison of surgical outcomes between the two techniques.
Collapse
Affiliation(s)
- Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Su-Hyeon Choi
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Yong-Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Seung-Hyun Kim
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Jin-Yu Lee
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Chul-Kwon Lim
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Jung-Bo Yang
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Joong-Gyu Ha
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Seok-Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| |
Collapse
|
5
|
García-Cabra DA, Montoya-Alvarez S, Ordorica-Flores RM, Ochoa-Toledo L, Lorias-Espinoza D, Pérez-Escamirosa F. Novices' learning curve in single-port surgery using three surgical training programs. MINIM INVASIV THER 2024; 33:90-101. [PMID: 38109095 DOI: 10.1080/13645706.2023.2293917] [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] [Received: 02/27/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the novices' learning curves and proficiency level reached in laparoendoscopic single-site (LESS) surgery using three surgical training programs. MATERIAL AND METHODS Participants were randomly divided into three groups, who trained in a specific practice regimen for 12 days using a laparoscopic box simulator and three tasks. Group A trained in three stages using conventional laparoscopic surgery (CLS) with straight instruments, and LESS with straight and articulating instruments for four days each. Group B trained in two stages in LESS with straight and articulating instruments for six days each. Group C trained only in LESS with articulating instruments exclusively for all 12 days. Performance was registered daily during the 12 days to evaluate the participants' progress. RESULTS Pre- and post-training analysis of the three groups showed significant differences in performance, denoting the significant improvement in their LESS skills, with no difference between the groups. Group C reached a high level of technical competence with their specific training program in LESS, obtaining a lower asymptote and slow learning rate. CONCLUSION Specific training programs in LESS settings using articulated instruments showed a slower learning rate than the other programs but better proficiency in the technique with the best surgical performance.
Collapse
Affiliation(s)
- Damaris Areli García-Cabra
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
- Facultad de Medicina, Universidad Veracruzana, Managua, Veracruz, México
| | - Salvador Montoya-Alvarez
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | | | - Luis Ochoa-Toledo
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Daniel Lorias-Espinoza
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | - Fernando Pérez-Escamirosa
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| |
Collapse
|
6
|
Yadav P, Chaudhari K, Dave A, Sindhu A. Exploring the Evolution of Robotic Surgery in Obstetrics and Gynecology: Past, Present, and Future Perspectives. Cureus 2024; 16:e57155. [PMID: 38681448 PMCID: PMC11055614 DOI: 10.7759/cureus.57155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Robotic surgery has emerged as a transformative technology in obstetrics and gynecology, offering enhanced precision and minimally invasive techniques for various procedures. This paper explores the evolution of robotic surgery in obstetrics and gynecology, examining its historical development, current applications, and prospects. Through a comprehensive review of the literature and case studies, we highlight the benefits of robotic surgery, including reduced trauma, improved patient outcomes, and increased surgeon capabilities. However, cost, training requirements, and regulatory concerns hinder widespread adoption. Continuing technological innovation is expected to enhance the efficacy and applicability of robotic-assisted procedures. Collaboration between healthcare professionals, researchers, and industry stakeholders is essential to address these challenges and ensure optimal patient care. By embracing the opportunities presented by robotic surgery while addressing associated challenges, practitioners and researchers can contribute to the continued advancement of this transformative technology in obstetrics and gynecology.
Collapse
Affiliation(s)
- Pallavi Yadav
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Apoorva Dave
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arman Sindhu
- Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
7
|
Daykan Y, Rotem R, O'Reilly BA. Robot-assisted laparoscopic pelvic floor surgery: Review. Best Pract Res Clin Obstet Gynaecol 2023; 91:102418. [PMID: 37776580 DOI: 10.1016/j.bpobgyn.2023.102418] [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: 12/19/2022] [Revised: 07/22/2023] [Accepted: 08/26/2023] [Indexed: 10/02/2023]
Abstract
Minimally invasive surgical techniques have become more common in pelvic floor reconstructive urogynaecological surgery, specifically, robotic-assisted pelvic floor surgery. Female pelvic floor anatomy is complex, and some repairs require highly experienced surgical skills that can be gained more easily using robotic-assisted surgery. A common application of the robotic platform in urogynaecological surgeries includes sacrocolpopexy, which has become the gold standard approach in the last decade for the correction of apical prolapse. Additional procedures include sacrohysteropexy, sacrocervicopexy, fistula repair, and complex procedures involving the bladder and other pelvic organs. Despite its increasing use and clear benefit in our field, data in the literature and, in particular, randomised controlled trials are sparse. This review provides an update, incorporating recently published literature and our personal experience in that field.
Collapse
Affiliation(s)
- Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Reut Rotem
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Barry A O'Reilly
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland
| |
Collapse
|
8
|
Noh JJ, Jeon JE, Jung JH, Kim TJ. Feasibility and Surgical Outcomes of Hybrid Robotic Single-Site Hysterectomy Compared with Single-Port Access Total Laparoscopic Hysterectomy. J Pers Med 2023; 13:1178. [PMID: 37511791 PMCID: PMC10382033 DOI: 10.3390/jpm13071178] [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: 07/02/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
We compared surgical outcomes between single-port access total laparoscopic hysterectomy (SPA-TLH) and hybrid robotic single-site hysterectomy (RSSH), a new technique of combining the benefits of SPA-TLH with RSSH in this study. A total of 64 patients were retrospectively analyzed. They underwent either hybrid RSSH or SPA-TLH for benign gynecologic disease between December 2018 and August 2021. To assess the feasibility of hybrid RSSH, the clinical characteristics and surgical outcomes were compared between the hybrid RSSH group (n = 29) and the SPA-TLH group (n = 35). All of the surgeries were completed without requiring additional ports or conversion to laparotomy. The surgical outcomes including total operative time, uterine weight, estimated blood loss, hemoglobin changes, length of hospital stay, and postoperative pain scores were not significantly different between the two groups. The colpotomy time, including the detachment of the uterosacral and cardinal ligaments, was shorter in the hybrid RSSH group than in the SPA-TLH group (8.0 min vs. 14.0 min; p = 0.029). However, the vaginal cuff closure time was longer in the hybrid RSSH group than in the SPA-TLH group (15.0 min vs.10.0 min; p = 0.001). No difference was observed with regards to intraoperative and postoperative complications. Hybrid RSSH appears to be a feasible procedure for hysterectomy in patients with benign gynecologic diseases.
Collapse
Affiliation(s)
- Joseph J Noh
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jung-Eun Jeon
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Ji-Hee Jung
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Tae-Joong Kim
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| |
Collapse
|
9
|
Riemma G, Pasanisi F, Reino A, Solazzo MC, Ronsini C. Robotic Single-Site Hysterectomy in Gynecologic Benign Pathology: A Systematic Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020411. [PMID: 36837612 PMCID: PMC9966893 DOI: 10.3390/medicina59020411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Background and objectives: Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site surgery (RSS) as an acceptable alternative to laparoendoscopic surgery combines the advantages of robotics with the aesthetic result of a single incision. This study aims to review the existing literature on a single-site robotic hysterectomy in patients with benign pathologies and verify its safety and feasibility. Materials and Methods: Following the recommendations in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, FP and AR systematically screened the PubMed, Embase, and Scopus databases. No temporal or geographical limitation was discriminatory. Studies containing data about feasibility and safety were included. Results: From 219, only eight studies met the inclusion criteria, and a total of 212 patients were included with a mean patient age of 45.42 years old (range 28-49.5 years old) and a mean BMI of 25.74 kg/m2 (range 22-28.5 kg/m2). The mean presurgical time, including port placement and docking time, was 15.56 (range 3-30) minutes. Mean console time was reported in six studies and is 83.21 min (range 25-180 min). The mean operative time is 136.6 min (range 60-294 min) and the mean blood loss is 43.68 mL (range 15-300 mL). Only two patients in the total analyzed had intraoperative complications and no conversion to LPT occurred. The median hospital stay was 1.71 days (range 0.96-3.5 days). The postoperative complication rate was estimated at 1.4% (vaginal bleeding). Conclusions: Our review supports the safety and feasibility of robotic single-site hysterectomy for benign gynecological diseases.
Collapse
|
10
|
Nobbenhuis MAE, Gul N, Barton-Smith P, O'Sullivan O, Moss E, Ind TEJ. Robotic surgery in gynaecology: Scientific Impact Paper No. 71 (July 2022). BJOG 2022; 130:e1-e8. [PMID: 35844092 DOI: 10.1111/1471-0528.17242] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The use of robotic-assisted keyhole surgery in gynaecology has expanded in recent years owing to technical advances. These include 3D viewing leading to improved depth perception, limitation of tremor, potential for greater precision and discrimination of tissues, a shorter learning curve and improved comfort for surgeons compared with conventional keyhole and open abdominal surgery. Robotic-assisted keyhole surgery, compared with conventional keyhole surgery, improves surgical performance without increasing operating time, minimises blood loss and intra- or postoperative complications, while reducing the need to revert to abdominal surgery. Moreover, surgeons using a robot experience fewer skeletomuscular problems of their own in the short and long term than those operating without a robot as an additional tool. This Scientific Impact Paper looks at the use of a robot in different fields of gynaecological surgery. A robot could be considered safe and a more effective surgical tool than conventional keyhole surgery for women who have to undergo complex gynaecology surgery or have associated medical issues such as body-mass index (BMI) at 30 kg/m2 or above or lung problems. The introduction of the use of robots in keyhole surgery has resulted in a decrease in the number of traditional open surgeries and the risk of conversion to open surgery after traditional keyhole surgery; both of which should be considered when examining the cost-benefit of using a robot. Limitations of robotic-assisted surgery remain the associated higher costs. In womb cancer surgery there is good evidence that introducing robotics into the service improves outcomes for women and may reduce costs.
Collapse
|
11
|
Youssef Y, Afaneh H, Borahay MA. Strategies for Cost Optimization in Minimally Invasive Gynecologic Surgery. JSLS 2022; 26:JSLS.2022.00015. [PMID: 36071991 PMCID: PMC9385110 DOI: 10.4293/jsls.2022.00015] [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] [Indexed: 11/22/2022] Open
Abstract
Background: Cost and quality are important, complex, and intertwined surgical outcomes. Evidence suggests that major cost drivers include operating room time, length of stay, re-admission, surgical complications, and quality of pre-operative and operative care in general. Our practices shape both costs and quality of gynecologic surgery. Various factors are explored in this review article to present and identify ways to implement cost-effective change that also improve quality of patient care. Database: We searched MEDLINE and PubMed databases for relevant articles. Discussion: Clinical preferences and decisions, surgeon experience, trainee education, and defensive medicine can influence cost. In addition, an incongruent physician-administration relationship may impact decisions across the healthcare system. The accelerating adoption of minimally invasive surgery, particularly the robotic approach, presents both an opportunity and a challenge. An example of practices that improve outcomes, patient satisfaction, and cut cost is pre-operative optimization, enhanced recovery after surgery, and the growing adoption of outpatient hysterectomy. The identification of cost-drivers and finding strategies to improve them would simultaneously improve quality and patient outcomes while reducing costs in minimally invasive gynecologic surgery.
Collapse
Affiliation(s)
- Youssef Youssef
- Department of Obstetrics and Gynecology, Hurley Medical Center/Michigan State University College of Human Medicine, Flint, MI
| | - Huda Afaneh
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
12
|
Truong MD, Tholemeier LN. Role of Robotic Surgery in Benign Gynecology. Obstet Gynecol Clin North Am 2022; 49:273-286. [DOI: 10.1016/j.ogc.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Bixel K, Barrington DA, Vetter MH, Suarez AA, Felix AS. Determinants of Surgical Approach and Survival Among Women with Endometrial Carcinoma. J Minim Invasive Gynecol 2022; 29:219-230. [PMID: 34348183 PMCID: PMC8803987 DOI: 10.1016/j.jmig.2021.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE To investigate determinants of surgical approach among women with endometrial carcinoma (EC) and associations between surgical approach and overall survival (OS). DESIGN Retrospective cohort. SETTING The National Cancer Database, 2010 to 2015. PATIENTS A total of 140 470 patients with histologically confirmed EC who underwent hysterectomy. INTERVENTIONS Patients were grouped according to surgical approach. MEASUREMENTS AND MAIN RESULTS A total of 140 470 patients with EC were included. Robotic-assisted laparoscopy (RAL) was the most common surgical approach (48.8%), followed by laparotomy (33.6%) and traditional laparoscopy (17.6%). Use of RAL increased over the study period, and the percentages of cases managed by laparotomy decreased. Older women, those with insurance, residing in ZIP codes with lower proportions of individuals who did not graduate from high school, and those treated at noncommunity cancer programs were less likely to undergo laparotomy than RAL, and non-white women, those diagnosed with high-grade histology, and those with advanced-stage EC were more likely to undergo laparotomy than RAL. Compared with RAL, all other surgical approaches were associated with worse OS (laparotomy: hazard ratio 1.21; 95% confidence interval, 1.18-1.25; traditional laparoscopy: hazard ratio 1.06; 95% confidence interval, 1.02-1.09). Significant effect modification of the surgical approach and OS relationship according to age, race, histology, stage, and adjuvant treatment was observed. CONCLUSION RAL increased in frequency over the study period and was associated with improved OS, supporting the continued use of RAL for EC management.
Collapse
Affiliation(s)
- Kristin Bixel
- Division of Gynecologic Oncology (Drs. Bixel and Barrington).
| | | | - Monica H Vetter
- Division of Gynecologic Oncology, Baptist Health Medicine Group, Lexington, Kentucky (Dr. Vetter)
| | - Adrian A Suarez
- Division of Surgical Pathology (Dr. Suarez), College of Medicine
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health (Dr. Felix), The Ohio State University, Columbus, Ohio
| |
Collapse
|
14
|
Buote NJ. Updates in Laparoscopy. Vet Clin North Am Small Anim Pract 2022; 52:513-529. [DOI: 10.1016/j.cvsm.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
15
|
Chang CL, Chen CH, Yang SSD, Chang SJ. An updated systematic review and network meta-analysis comparing open, laparoscopic and robotic-assisted sacrocolpopexy for managing pelvic organ prolapse. J Robot Surg 2021; 16:1037-1045. [PMID: 34779989 DOI: 10.1007/s11701-021-01329-x] [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: 06/29/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
Abdominal sacrocolpopexy is considered as the gold standard treatment for pelvic organ prolapse. Sacrocolpopexy can be performed using open (OSC), laparoscopic (LSC), and robotic-assisted (RSC) approaches. The aim of this study is to compare the outcomes between these three approaches for managing pelvic organ prolapse by conducting a systematic review and network meta-analysis. A systematic search was performed in different databases from their earliest records to April 2021 with no restriction on languages. Only randomized controlled trials that compared the outcomes between OSC, LSC, and RSC were included in this study. A total of 6 studies with 486 participants were included in this study. Operative time was significantly shorter in OSC than in RSC and LSC. The probability rank showed less estimated blood loss in RSC and lowest overall postoperative complications in LSC. Probability scores also showed best anatomical outcomes for postoperative points C and Bp in RSC and for point Ba in LSC. Despite significantly longer operative time, RSC and LSC may provide better anatomical outcomes, less estimated blood loss, and less overall postoperative complications than OSC. However, this study did not find significant differences between RSC and LSC in efficacy and safety.
Collapse
Affiliation(s)
- Chia-Lun Chang
- Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City, 231, Taiwan.,School of Medicine, Tzu Chi University, Hualien City, 970, Taiwan
| | - Chun-Hua Chen
- Department of Neurology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City, 231, Taiwan.,School of Medicine, Tzu Chi University, Hualien City, 970, Taiwan
| | - Shang-Jen Chang
- Division of Urology, Taipei Tzu Chi Hospital, Tzu Chi Medical Foundation, New Taipei City, 231, Taiwan. .,School of Medicine, Tzu Chi University, Hualien City, 970, Taiwan.
| |
Collapse
|
16
|
Cameron-Jeffs R, Yong C, Carey M. Robotic-assisted gynaecological surgery in Australia: current trends, challenges and future possibility. ANZ J Surg 2021; 91:2246-2249. [PMID: 34766675 DOI: 10.1111/ans.17292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Chin Yong
- Pelvic Floor Unit, The Royal Women's Hospital, Parkville, Australia.,Pelvic Floor Centre of Excellence at Epworth, Epworth Freemasons Hospital, East Melbourne, Australia
| | - Marcus Carey
- Pelvic Floor Unit, The Royal Women's Hospital, Parkville, Australia.,Pelvic Floor Centre of Excellence at Epworth, Epworth Freemasons Hospital, East Melbourne, Australia
| |
Collapse
|
17
|
Marchand G, Taher Masoud A, Ware K, Govindan M, King A, Ruther S, Brazil G, Calteux N, Coriell C, Ulibarri H, Parise J, Arroyo A, Filippelli C, Loli H, Sainz K. Systematic review and meta-analysis of all randomized controlled trials comparing gynecologic laparoscopic procedures with and without robotic assistance. Eur J Obstet Gynecol Reprod Biol 2021; 265:30-38. [PMID: 34418694 DOI: 10.1016/j.ejogrb.2021.07.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Following the publication of several high quality randomized controlled trials regarding the comparison of similar laparoscopic gynecologic procedures being performed with or without robotic assistance, we aimed to perform a systematic review to identify any differences in patient safety and expected incidence of complications in these procedures. DATA SOURCES Articles on ClinicalTrials.Gov, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases were retrieved and screened for eligibility up to April 1st 2021. METHODS OF STUDY SELECTION In addition to meeting our screening algorithm, we included studies that met all the following: randomized control trials (RCT), enrolling patients for indicated laparoscopic gynecologic procedures, and comparing Robotic Surgery (RS) with Laparoscopic Surgery (LS) in terms of safety or complications. TABULATION, INTEGRATION, AND RESULTS Data was pooled as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI). Ultimately, six studies were included in this meta-analysis. Pooled data revealed that RS and LS have similar risk for intraoperative complications (RR = 0.87; 95% CI [0.23, 3.36], P = 0.84), postoperative complications (RR = 1.07; 95% CI [0.57, 2.01], P = 0.83), significant intraoperative hemorrhage (RR = 1.40; 95% CI [0.59, 3.34], P = 0.44), postoperative hemorrhage (RR = 0.43; 95% CI [0.15, 1.22], P = 0.11), vaginal cuff dehiscence (RR = 1.13; 95% CI [0.24, 5.41], P = 0.88), postoperative wound infection, urinary tract infection, and urinary bladder or ureteral injury. RS had "surgeon declared" lower estimated blood loss (MD = 85.27; 95% CI [46.45, 124.09], P < 0.00001) and shorter postoperative hospital stay (MD = 1.20; 95% CI [0.38, 2.01], P = 0.004). CONCLUSION There was a statistically significant decrease in hospital stay and "surgeon declared" blood loss seen in the RS group. There was no statistically significant increase in risk of developing other postoperative complications between the LS and R groups.
Collapse
Affiliation(s)
- Greg Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA.
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA; Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Kelly Ware
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA; International University of Health Sciences, Basseterre, Saint Kitts and Nevis
| | - Malini Govindan
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Stacy Ruther
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Nicolas Calteux
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | | | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Candace Filippelli
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, USA
| | - Helen Loli
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, USA
| | - Katelyn Sainz
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| |
Collapse
|
18
|
Abstract
The use of robotic-assisted laparoscopic surgery has continued to grow since the Food and Drug Administration approval for robotic-assisted gynecologic surgery in 2005. However, despite this growth in utilization, the data supporting its use in benign gynecologic surgery has not strongly supported its advantages over conventional laparoscopy. Controversy exists between supporters of robotic-assisted laparoscopic surgery and conventional laparoscopy. This article discusses the current literature regarding the use of robotic-assisted surgery in benign gynecologic surgery.
Collapse
|
19
|
Comparing the outcomes and effectiveness of robotic-assisted sacrocolpopexy and laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse. Int Urogynecol J 2021; 33:297-308. [PMID: 33760992 DOI: 10.1007/s00192-021-04741-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Abdominal sacrocolpopexy is regarded as the gold standard for management of pelvic organ prolapse (POP). Nowadays, minimally invasive surgeries are preferred, and sacrocolpopexy can be performed using either a laparoscopic or robotic-assisted approach. The aim of the current study was to compare the efficacy and safety of robotic-assisted sacrocolpopexy (RASC) and laparoscopic sacrocolpopexy (LSC) through an updated systematic review and meta-analysis. METHODS We performed a systematic literature review of different databases and related references from their inception until July 2020 without language restrictions. All randomized control trials and comparative studies that compared RASC and LSC for the management of POP were included. RESULTS A total of 13 studies including 2115 participants were included for the pooled analysis. The pooled results revealed that RASC was associated with a significantly longer operative time (weighted mean difference, 29.53 min; 95% confidence interval [CI], 12.88 to 46.18 min, P = 0.0005), significantly less estimated blood loss (weighted mean difference, -86.52 ml; 95% CI -130.26 to -42.79 ml, P = 0.0001), significantly fewer overall intraoperative complications (odds ratio [OR] 0.6; 95% CI 0.40 to 0.91; P = 0.01) and significantly lower conversion rate (OR 0.39; 95% CI 0.19 to 0.82; P = 0.01) compared with LSC. There were no significant differences between the length of hospital stays, overall postoperative complications, postoperative stress incontinence, mesh erosion and effectiveness between the two groups. CONCLUSION The current study showed comparable efficacy between RASC and LSC. Though RASC was associated with less blood loss and a lower conversion rate, the differences were not clinically significant. The choice of surgical procedure with either RASC or LSC is according to surgeon discretion and patient preferences.
Collapse
|
20
|
Lee SR, Lee ES, Eum HR, Lee YJ, Lee SW, Park JY, Suh DS, Kim DY, Kim SH, Kim YM, Kim YT. New Surgical Technique for Robotic Myomectomy: Continuous Locking Suture on Myoma (LSOM) Technique. J Clin Med 2021; 10:654. [PMID: 33567699 PMCID: PMC7914728 DOI: 10.3390/jcm10040654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 12/26/2022] Open
Abstract
Robot-assisted laparoscopic myomectomy (RALM) has broadened the indications even in complex myomas. However, the high cost of RALM remains the main disadvantage. Therefore, a surgical technique that can reduce the cost of RALM and still has the advantages of robotic surgery is required. We propose a "locking suture on myoma (LSOM)" technique and compared the operative and perioperative outcomes of patients who underwent RALM with or without the LSOM technique. We included 337 patients who underwent RALM with (n = 160) or without (n = 177) the LSOM technique between March 2019 and August 2020. The LSOM group had low parity and gravidity, with a low rate of Cesarean sections. Myoma type was not different between the groups; however, patients in the LSOM group had larger, heavier, and higher number of myomas, although fewer patients had multiple myomas and were discharged earlier. Total operating time, estimated blood loss, pre- and postoperative hemoglobin levels, transfusion rate, and postoperative fever were not different between the two groups. In conclusion, the LSOM technique may be a viable surgical option for myomas, as it can reduce the cost of RALM by obviating the need for robotic Tenaculum forceps.
Collapse
Affiliation(s)
- Sa Ra Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Korea;
| | - Hye Rim Eum
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Young-Jae Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Jeong Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Sung Hoon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Seoul Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (H.R.E.); (Y.-J.L.); (S.-W.L.); (J.Y.P.); (D.-S.S.); (D.-Y.K.); (S.H.K.); (Y.-M.K.); (Y.-T.K.)
| |
Collapse
|
21
|
Azadi S, Green IC, Arnold A, Truong M, Potts J, Martino MA. Robotic Surgery: The Impact of Simulation and Other Innovative Platforms on Performance and Training. J Minim Invasive Gynecol 2020; 28:490-495. [PMID: 33310145 DOI: 10.1016/j.jmig.2020.12.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To review the current status of robotic training and the impact of various training platforms on the performance of robotic surgical trainees. DATA SOURCES Literature review of Google Scholar and PubMed. The search terms included a combination of the following: "robotic training," "simulation," "robotic curriculum," "obgyn residency robotic training," "virtual reality robotic training," "DaVinci training," "surgical simulation," "gyn surgical training." The sources considered for inclusion included peer-reviewed articles, literature reviews, textbook chapters, and statements from various institutions involved in resident training. METHODS OF STUDY SELECTION A literature search of Google Scholar and PubMed using terms related to robotic surgery and robotics training, as mentioned in the "Data Sources" section. RESULTS Multiple novel platforms that use machine learning and real-time video feedback to teach and evaluate robotic surgical skills have been developed over recent years. Various training curricula, virtual reality simulators, and other robotic training tools have been shown to enhance robotic surgical education and improve surgical skills. The integration of didactic learning, simulation, and intraoperative teaching into more comprehensive training curricula shows positive effects on robotic skills proficiency. Few robotic surgery training curricula have been validated through peer-reviewed study, and there is more work to be completed in this area. In addition, there is a lack of information about how the skills obtained through robotics curricula and simulation translate into operating room performance and patient outcomes. CONCLUSION Data collected to date show promising advances in the training of robotic surgeons. A diverse array of curricula for training robotic surgeons continue to emerge, and existing teaching modalities are evolving to keep up with the rapidly growing demand for proficient robotic surgeons. Futures areas of growth include establishing competency benchmarks for existing training tools, validating existing curricula, and determining how to translate the acquired skills in simulation into performance in the operating room and patient outcomes. Many surgical training platforms are beginning to expand beyond discrete robotic skills training to procedure-specific and team training. There is still a wealth of research to be done to understand how to create an effective training experience for gynecologic surgical trainees and robotics teams.
Collapse
Affiliation(s)
- Shirin Azadi
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania (Drs. Azadi, Potts, and Martino)
| | - Isabel C Green
- Department of Gynecology and Obstetric, Mayo Clinic, Rochester, Minnesota (Dr. Green)
| | - Anne Arnold
- American College of Obstetricians and Gynecologists, University of Pennsylvania Graduate School of Education, Philadelphia, PA (Ms. Arnold)
| | - Mireille Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California (Dr. Truong)
| | - Jacqueline Potts
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania (Drs. Azadi, Potts, and Martino)
| | - Martin A Martino
- Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, Pennsylvania (Drs. Azadi, Potts, and Martino); Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida (Dr. Martino).
| |
Collapse
|
22
|
Heiden AL, Katebi Kashi P, Rose GS, Dengler KL. A four step strategy for robot assisted abdominal cerclage placement prior to pregnancy. Fertil Steril 2020; 114:902-904. [PMID: 32888677 DOI: 10.1016/j.fertnstert.2020.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To demonstrate a simple, stepwise strategy for robot-assisted abdominal cerclage placement before pregnancy. DESIGN Demonstrative video presentation. Surgical footage surrounding a case report is used to describe a four-step technique for robot-assisted abdominal cerclage placement in women with recurrent pregnancy loss or other anatomic variants before pregnancy. This video article was reviewed by the Investigational Review Board and further investigation was waived because the study was "not considered human subject research." SETTING Tertiary medical center. PATIENT(S) A 38-year-old G4P0220 (Gestations: 4, Term deliveries: 0, Preterm deliveries: 2, Abortions: 2, Living children: 0) with a history of two second trimester losses who had failed a prior history-indicated transvaginal cerclage (Fig. 1). INTERVENTION(S) The patient underwent an uncomplicated robot-assisted abdominal cerclage using a four-step strategy: Step 1, create the bladder flap; Step 2, identify pertinent anatomy; Step 3, place the cerclage; and Step 4, hysteroscopy. MAIN OUTCOME MEASURE(S) Intraoperative technique presenting a four-step method to ensure successful robot-assisted abdominal cerclage placement. RESULT(S) Robot-assisted abdominal cerclage is a safe, viable alternative to traditional abdominal cerclage placed via laparotomy. This video outlines four critical steps to facilitate placement and decrease patient morbidity. This patient did well operatively without increased blood loss or operative time and was discharged home on postoperative day 1. She went on to have a successful future pregnancy and currently is scheduled for an elective cesarean section at term. CONCLUSION(S) Abdominal cerclages significantly improve pregnancy and neonatal outcomes in women who previously have failed transvaginal cerclage. Robot-assisted abdominal cerclage placement allows a minimally invasive approach with enhanced dexterity and better visualization for the surgeon compared with conventional laparoscopy or laparotomy, as well as decreased pain and shorter recovery time for patients. This video demonstrates placement of a robot-assisted abdominal cerclage in a patient with recurrent pregnancy loss using a simple four-step strategy to ensure successful, correct, and easy placement. To our knowledge, this is the first video demonstrating a stepwise approach to robot-assisted abdominal cerclage placement.
Collapse
Affiliation(s)
- Allison L Heiden
- Department of Obstetrics and Gynecology, Inova Fairfax Medical Center, Falls Church, Virginia.
| | - Payam Katebi Kashi
- Department of Obstetrics and Gynecology, Inova Fairfax Medical Center, Falls Church, Virginia
| | - G Scott Rose
- Department of Obstetrics and Gynecology, Inova Fairfax Medical Center, Falls Church, Virginia
| | - Katherine L Dengler
- Department of Obstetrics and Gynecology, Inova Fairfax Medical Center, Falls Church, Virginia; Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland
| |
Collapse
|
23
|
Robotic Surgery Is Less Physically Demanding Than Laparoscopic Surgery: Paired Cross Sectional Study. Ann Surg 2020; 271:106-113. [PMID: 29923873 DOI: 10.1097/sla.0000000000002845] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To study musculoskeletal workload in experienced surgeons during laparoscopic surgery (LS) compared with robotic assisted laparoscopy (RALS). BACKGROUND 70-90% of surgeons who regularly perform LS report musculoskeletal symptoms, mainly in neck and shoulders. Data regarding the potential ergonomic benefits of RALS in a clinical setting is very limited. METHODS Twelve surgeons with advanced experience in both LS and RALS each performed 2 hysterectomies on the same day. LS was performed standing, RALS sitting, the latter allowing forearm and head support. Bipolar surface electromyogram (EMG) was recorded from several muscles and was expressed relative to EMG during maximum contractions (%EMGmax). Gaps per minute plus static (p0.1), mean (p0.5), and peak (p0.9) muscle activation were calculated. Perceived exertion was rated before and just after each surgery. RESULTS Neck muscle activity (p0.1 4.7 vs. 3.0%EMGmax, p0.5 7.4 vs. 5.3%EMGmax, p0.9 11.6 vs. 8.2%EMGmax, all P < 0.05) and static shoulder muscle activity (p0.1 5.7 vs. 2.8%EMGmax, P < 0.05) were higher for LS than for RALS. Both a higher level of gaps during RALS and a lower rating of perceived exertion, also for the legs, after RALS supported these observations. However, low back muscle activity was higher for RALS. CONCLUSIONS RALS is significantly less physically demanding than LS, and also feels less strenuous for the surgeons. However, for both types of surgeries, there still is room for improvement of working conditions. To further optimize these, we suggest a scheme to regularly observe and advise the surgeons.
Collapse
|
24
|
Li C, Hua K. The current status of sacrocolpopexy in the management of apical prolapse. MINERVA GINECOLOGICA 2020; 72:165-170. [PMID: 32315126 DOI: 10.23736/s0026-4784.20.04477-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pelvic organ prolapse (POP) is a prevalent condition that negatively affects women' s quality of life. There is growing recognition that adequate support for the vaginal apex is an important component of a durable surgical repair for women with advanced prolapse, including the anterior and posterior wall prolapse. Surgical treatment options include abdominal and vaginal approaches, the former of which can be performed open, laparoscopically, and robotically. Sacrocolpopexy is a common procedure designed for the treatment of prolapse including uterine or vaginal vault prolapse and multiple-compartment prolapse. Although traditionally performed as an open abdominal procedure, minimally invasive sacrocolpopexy, whether laparoscopic or robotic, has been successfully performed in the clinical practice by many pelvic reconstructive surgeons. In order to require an outstanding cosmetic result, transumbilical/transvaginal single-port sacrocolpopexy has been developed to achieve the goal and initial outcomes have demonstrated their efficacy, safety and feasibility. However, up to date, there are many variations to these procedures, with different levels of evidence to support each of them. Herein we reviewed the current literatures on current surgical choices for women with apical prolapse.
Collapse
Affiliation(s)
- Chunbo Li
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Keqin Hua
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China -
| |
Collapse
|
25
|
Smith AJB, AlAshqar A, Chaves KF, Borahay MA. Association of demographic, clinical, and hospital‐related factors with use of robotic hysterectomy for benign indications: A national database study. Int J Med Robot 2020; 16:e2107. [DOI: 10.1002/rcs.2107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/01/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Jo B. Smith
- Department of Gynecology and ObstetricsJohns Hopkins School of Medicine Baltimore Maryland USA
| | - Abdelrahman AlAshqar
- Department of Gynecology and ObstetricsJohns Hopkins School of Medicine Baltimore Maryland USA
- Department of Obstetrics and GynecologyKuwait University Kuwait City Kuwait
| | - Kate F. Chaves
- Department of Obstetrics and GynecologyVanderbilt University Medical Center Nashville Tennessee USA
| | - Mostafa A. Borahay
- Department of Gynecology and ObstetricsJohns Hopkins School of Medicine Baltimore Maryland USA
| |
Collapse
|
26
|
Laganà AS, Garzon S, Raffaelli R, Gullo G, Franchi M. Robotic Surgery in Female-To-Male Transition: A Possible Way for Further Improvement. J INVEST SURG 2019; 34:651-652. [DOI: 10.1080/08941939.2019.1686092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Giuseppe Gullo
- Department of Obstetrics and Gynecology, AOOR Villa Sofia Cervello, IVF Public Center, Palermo, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| |
Collapse
|
27
|
Pelizzo G, Nakib G, Calcaterra V. Pediatric and adolescent gynecology: Treatment perspectives in minimally invasive surgery. Pediatr Rep 2019; 11:8029. [PMID: 31871603 PMCID: PMC6908954 DOI: 10.4081/pr.2019.8029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/05/2019] [Indexed: 12/01/2022] Open
Abstract
Minimally invasive surgery (MIS) is widely utilized across multiple surgical disciplines, including gynecology. To date, laparoscopy is considered a common surgical modality in children and adolescents to treat gynecological conditions. Robotic surgical devices were developed to circumvent the limitations of laparoscopy and have expanded the surgical armamentarium with better magnification, dexterity enhanced articulating instruments with 5-7 degrees of freedom, and ability to scale motion thus eliminating physiologic tremor. There are well-documented advantages of MIS over laparotomy, including decreased post-operative pain, shorter recovery times, and better cosmetic results. Indications for MIS in pediatric gynecology are reported in this review and technical considerations are described to highlight new treatment perspectives in children and adolescents, which have already been described in the literature regarding adult patients.
Collapse
Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, Children's Hospital, ARNASCivico-Di Cristina-Benfratelli, Palermo, Italy
| | - Ghassan Nakib
- Department of Pediatric Surgery, Mediclinic Middle East, Mediclinic City Hospital Dubai, UAE
| | - Valeria Calcaterra
- Pediatric Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Italy
| |
Collapse
|
28
|
Mortality Rates in Laparoscopic and Robotic Gynecologic Oncology Surgery: A Systemic Review and Meta-analysis. J Minim Invasive Gynecol 2019; 26:1253-1267.e4. [DOI: 10.1016/j.jmig.2019.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022]
|
29
|
|
30
|
Bixel KL, Fowler JM. Fertility-sparing surgery for early-stage cervical cancer: does surgical approach have an impact on disease outcomes? Am J Obstet Gynecol 2019; 220:417-419. [PMID: 31076039 DOI: 10.1016/j.ajog.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
|
31
|
Safety of robotic-assisted gynecologic surgery and early hospital discharge in elderly patients. Am J Obstet Gynecol 2019; 220:253.e1-253.e7. [PMID: 30557552 DOI: 10.1016/j.ajog.2018.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND A minimally invasive surgical approach has proven to decrease peri- and postoperative complications and shorten duration of hospital stay; however, there are limited data evaluating the safety of robotic-assisted surgery and early hospital discharge in the elderly population. Because age is a well-known, independent risk factor for perioperative morbidity and gynecologists treat many elderly patients, this is an important area of study. OBJECTIVE The objective of the study was to evaluate discharge timing and surgical outcomes in elderly compared with younger patients undergoing robotic-assisted gynecologic surgery. STUDY DESIGN This was a retrospective cohort study of all patients who underwent robotic-assisted gynecologic surgery at a high-volume, single institution from January 2013 through May 2016. Demographic information, discharge timing, and peri- and postoperative outcomes were compared for patients <65 years with those ≥65 years using univariate and multivariate analyses. RESULTS There were 2757 patients included, with 2521 <65 years and 236 ≥65 years. Median age of the younger group was 42 years, while the median age of the elderly group was 69 years. Elderly patients had a higher body mass index (kilograms per square meter) (28 vs 26, P < .001) and higher American Society of Anesthesia classification (P < .001). Elderly were more likely to have malignancy as the indication for surgery (68% vs 11%, P < .001) and to undergo hysterectomy (81% vs 38%, P < .001) or surgery with lymph node dissection (44.5% vs 7.1%, P < .001). Elderly patients had a higher incidence of intraoperative complications (9% vs 4.6%, P = .002) and longer median hospital stay (17 vs 7 hours, P < .001) compared with younger patients. Same-day discharge was more common in younger patients (76% vs 45%, P < .001), and elderly patients were more likely to have admissions lasting >23 hours (13% vs 3%, P < .001) on univariate and multivariate analysis. Analysis of postoperative outcomes included 2023 patients with available postoperative data (80% of total population) (1794 <65 years, 229 ≥ 65 years). There were no differences between elderly and younger patients in overall postoperative complications, reoperations, intensive care unit admissions, emergency room visits, or hospital readmission within 6 weeks of surgery. CONCLUSION Despite having more preoperative risk factors and more surgically complex procedures, elderly patients undergoing robotic-assisted gynecologic surgery had similar postoperative complication rates, and almost half of elderly patients were safely discharged the day of surgery. Our data suggest that robotic-assisted gynecologic surgery and early hospital discharge are safe in elderly patients.
Collapse
|
32
|
Moawad GN, Tyan P, Paek J, Tappy EE, Park D, Choussein S, Srouji SS, Gargiulo A. Comparison between single-site and multiport robot-assisted myomectomy. J Robot Surg 2019; 13:757-764. [DOI: 10.1007/s11701-019-00919-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
|
33
|
Gingold JA, Gueye NA, Falcone T. Minimally Invasive Approaches to Myoma Management. J Minim Invasive Gynecol 2018; 25:237-250. [DOI: 10.1016/j.jmig.2017.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
|
34
|
Robot-assisted myomectomy. Best Pract Res Clin Obstet Gynaecol 2018; 46:113-119. [PMID: 29103894 DOI: 10.1016/j.bpobgyn.2017.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022]
Abstract
Uterine fibroids are the most common tumors of the uterus and the female pelvis and are associated with substantial morbidity for several women. In women with a wish to preserve fertility, a myomectomy is the surgical procedure of choice when medical therapy is inadequate. Despite evidence that minimally invasive surgery is preferable to laparotomy, most myomectomies are still performed by laparotomy. Robotic surgery was introduced to overcome some of the difficulties associated with laparoscopic surgery. A myomectomy is a suture-intensive surgery where the properties of a surgical robot have been suggested to be of particular value. Robotic myomectomy is feasible and safe, with similar outcome to laparoscopic surgery, although a robotic procedure is associated with a higher cost. The introduction of robotic surgery has expanded the indications for minimally invasive myomectomy to more complex cases previously performed by laparotomy. Randomized trials comparing different approaches to myomectomy are yet to be published. More studies are needed to determine the patients in whom a robotic approach is most beneficial, both in terms of patient outcomes and cost efficiency.
Collapse
|
35
|
Moawad G, Liu E, Song C, Fu AZ. Movement to outpatient hysterectomy for benign indications in the United States, 2008-2014. PLoS One 2017; 12:e0188812. [PMID: 29190666 PMCID: PMC5708798 DOI: 10.1371/journal.pone.0188812] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The past decade has witnessed adoption of conservative gynecologic treatments, including minimally invasive surgery (MIS), alongside steady declines in inpatient hysterectomies. It remains unclear what factors have contributed to trends in outpatient benign hysterectomy (BH), as well as whether these trends exacerbate disparities. MATERIALS AND METHODS Retrospective cohort of 527,964 women ≥18 years old who underwent BH from 2008 to 2014. BH surgical approaches included: open/abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and robotic-assisted hysterectomy (RH). Quarterly frequencies were calculated by care setting and surgical approach. We used multilevel logistic regression (MLR) using the most recent year of data (2014) to examine the influence of patient-, physician-, and hospital-level preoperative factors and surgical approaches on outpatient migration. RESULTS From 2008-2014, surgical approaches for LH and RH increased, which coincided with decreases in VH and AH. Overall, a 44.2% shift was observed from inpatient to outpatient settings (P<0.0001). Among all outpatient visits MIS increased, particularly for RH (3.6% to 41.07%). We observed increases in the proportion of non-Hispanic Black and Medicaid patients who obtained MIS in 2014 vs. 2008 (P<0.001). Surgical approach (51.8%) and physician outpatient MIS experience (19.9%) had the greatest influence on predicting outpatient BH. Compared with LH, RH was associated with statistically significantly higher likelihood of outpatient BH overall (OR 1.23; 95% CI, 1.16-1.31), as well as in sub-analyses of more complex cases and hospitals that performed ≥1 RH (P<0.05). CONCLUSION From 2008-2014, rates of LH and RH significantly increased. A significant shift from inpatient to outpatient setting was observed. These findings suggest that RH may facilitate the shift to outpatient BH, particularly for patients with complexities. The adoption of MIS in outpatient settings may improve access to disadvantaged patient groups.
Collapse
Affiliation(s)
- Gaby Moawad
- George Washington University, Washington, DC, United States of America
| | - Emelline Liu
- Intuitive Surgical, Inc, Sunnyvale, California, United States of America
| | - Chao Song
- Intuitive Surgical, Inc, Sunnyvale, California, United States of America
| | - Alex Z. Fu
- Georgetown University Medical Center, Washington, DC, United States of America
| |
Collapse
|
36
|
Role of robotic surgery in treating fibroids and benign uterine mass. Best Pract Res Clin Obstet Gynaecol 2017; 45:48-59. [PMID: 28551090 DOI: 10.1016/j.bpobgyn.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/22/2017] [Accepted: 04/14/2017] [Indexed: 12/31/2022]
Abstract
Fibroid uterus can be managed medically, surgically, or through non-extirpative procedures, depending on the clinical situation. Myomectomy may be beneficial, especially to those desiring to preserve the uterus and/or fertility, with outcomes comparable to those of hysterectomy, with a laparoscopic approach being favored when feasible. For definitive therapy, hysterectomy can be pursued where the surgical approach should be individualized. Comparison of robotic-assisted laparoscopic approach shows that the robotic approach may be favored for cases with higher complexity and multiple fibroids in myomectomy; however, no clear advantage is seen with hysterectomy at this time, necessitating further research in the area of robotics for hysterectomy in benign uterine mass treatment to justify the cost.
Collapse
|
37
|
Abstract
Minimally invasive hysterectomy via the laparoscopic or vaginal approach is beneficial to patients when compared with laparotomy, but has not been offered in the past to all women because of the technical difficulties and the long learning curve required for laparoscopic hysterectomy. Robotic-assisted hysterectomy for benign indications may allow for a shorter learning curve but does not offer clear advantages over conventional laparoscopic hysterectomy in terms of surgical outcomes. In addition, robotic hysterectomy is invariably associated with increased costs. Nevertheless, this surgical approach has been widely adopted by gynecologic surgeons. The aim of this review is to describe specific indications and patients who may benefit from robotic-assisted hysterectomy. These include hysterectomy for benign conditions in cases with high surgical complexity (such as pelvic adhesive disease and endometriosis), hysterectomy and lymphadenectomy for treatment of endometrial carcinoma, and obese patients. In the future, additional evidence regarding the benefits of single-site robotic hysterectomy may further modify the indications for robotic-assisted hysterectomy.
Collapse
Affiliation(s)
- Noam Smorgick
- Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
38
|
Pereira N, Frankel WC, Hutchinson AP, Patel HH, Mostisser C, Elias RT. Temporal trends in minimally invasive myomectomy before and after the US Food and Drug Administration recommendation against electric morcellation. Int J Gynaecol Obstet 2017; 137:295-300. [DOI: 10.1002/ijgo.12128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/16/2017] [Accepted: 02/13/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Nigel Pereira
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine; Weill Cornell Medical Center; New York NY USA
| | - William C. Frankel
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine; Weill Cornell Medical Center; New York NY USA
| | - Anne P. Hutchinson
- Department of Obstetrics and Gynecology; Weill Cornell Medical College; New York NY USA
| | - Hency H. Patel
- Department of Obstetrics and Gynecology; Weill Cornell Medical College; New York NY USA
| | - Cheri Mostisser
- Department of Obstetrics and Gynecology; Weill Cornell Medical College; New York NY USA
| | - Rony T. Elias
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine; Weill Cornell Medical Center; New York NY USA
| |
Collapse
|