Gynaecological robotic surgery at a state hospital — our own experience
Abstract
Objectives: In recent years, the rapid development of minimally invasive surgical methods, including robotic surgery, has resulted in a marked decline of the traditional methods in gynaecological surgery. The aim of the study was to share our experience with robotic surgery at a state hospital.
Material and methods: A total of 40 patients, who underwent robotic gynaecological surgery (GS) between 2015 and 2017, were included. Age, BMI, previous abdominal operations (PAO), operation indications (OI), operative time (OT), pathological evaluation, uterine weight (UW), blood loss during surgery (BL), complications, and duration of the hospitalization (DoH) were analyzed. The Da Vinci XI was used during surgery.
Results: A total of 40 patients were analyzed. Mean values were as follows: age — 48 years, BMI — 28, and PAO — 12%. The most common OI included uterine fibroids (52%) and abnormal uterine bleeding (45%). Mean OT, docking time and console time values were 166 min, 15 min, and 123 min, respectively. Mean BL was 93 mL. Mean UW was 256 gr, and DoH was 4 days. Perioperative and postoperative complications were observed in 10% and 20% of the cases, respectively.
Conclusions: Robotic-assisted surgery is invaluable in gynaecology, especially in the case of endometriosis, extensive adhesion, and in some oncological patients, as it allows for better visualization and higher maneuverability. In order for a surgeon to prepare for such cases, the use of the robot in benign cases is necessary to complete the learning curve and gain speed.
Keywords: robotic surgerybenign gynaecological disease
References
- Committee opinion no. 628: robotic surgery in gynecology. Obstet Gynecol. 2015; 125(3): 760–767.
- Committee on Gynecologic Practice. ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009; 114(5): 1156–1158.
- Davies BL, Hibberd RD, Coptcoat MJ, et al. A surgeon robot prostatectomy--a laboratory evaluation. J Med Eng Technol. 1989; 13(6): 273–277.
- Reynolds RK, Advincula AP. Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg. 2006; 191(4): 555–560.
- Wright JD, Ananth CV, Lewin SN, et al. Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA. 2013; 309(7): 689–698.
- Sokol AI, Green IC. Laparoscopic hysterectomy. Clin Obstet Gynecol. 2009; 52(3): 304–312.
- Landeen LB, Bell MC, Hubert HB, et al. Clinical and cost comparisons for hysterectomy via abdominal, standard laparoscopic, vaginal and robot-assisted approaches. S D Med. 2011; 64(6): 197–199, 201, 203 passim.
- Lönnerfors C, Reynisson P, Persson J. A randomized trial comparing vaginal and laparoscopic hysterectomy vs robot-assisted hysterectomy. J Minim Invasive Gynecol. 2015; 22(1): 78–86.
- Falcone T, Walters MD. Hysterectomy for benign disease. Obstet Gynecol. 2008; 111(3): 753–767.
- Holloway RW, Patel SD, Ahmad S. Robotic surgery in gynecology. Scand J Surg. 2009; 98(2): 96–109.
- Martínez-Maestre MA, Gambadauro P, González-Cejudo C, et al. Total laparoscopic hysterectomy with and without robotic assistance: a prospective controlled study. Surg Innov. 2014; 21(3): 250–255.
- Göçmen A, Sanlikan F, Uçar MG. Turkey's experience of robotic-assisted laparoscopic hysterectomy: a series of 25 consecutive cases. Arch Gynecol Obstet. 2010; 282(2): 163–171.
- Lim PC, Crane JT, English EJ, et al. Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications. Int J Gynaecol Obstet. 2016; 133(3): 359–364.
- O’Sullivan OE, O’Reilly BA. Gynecological Surgery and the Robot. Engineering. 2014; 06(02): 59–70.
- Andres Md, Borrelli GM, Abrão MS. Advances on minimally invasive approach for benign total hysterectomy: a systematic review. F1000Res. 2017; 6: 1295.
- Goetgheluck J, Carbonnel M, Ayoubi JM. Robotically assisted gynecologic surgery: 2-year experience in the French foch hospital. Front Surg. 2014; 1: 8.
- Albright BB, Witte T, Tofte AN, et al. Robotic Versus Laparoscopic Hysterectomy for Benign Disease: A Systematic Review and Meta-Analysis of Randomized Trials. J Minim Invasive Gynecol. 2016; 23(1): 18–27.
- Gutierrez AL, Binda ML, Ramos JG. Early Experience of Robotic Hysterectomy for Treatment of Benign Uterine Disease. Rev Bras Ginecol Obstet. 2016; 38(9): 450–455.
- Patzkowsky KE, As-Sanie S, Smorgick N, et al. Perioperative outcomes of robotic versus laparoscopic hysterectomy for benign disease. JSLS. 2013; 17(1): 100–106.
- Simpson KM, Advincula AP. The Essential Elements of a Robotic-Assisted Laparoscopic Hysterectomy. Obstet Gynecol Clin North Am. 2016; 43(3): 479–493.
- Aarts JWM, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015(8): CD003677.
