Robotically assisted laparoscopic microsurgical uterine horn anastomosis

Abstract

Objective: To evaluate the feasibility, safety, and sterility issues with regard to the use of a robotic device to perform uterine horn anastomosis in a live porcine model. Design: Prospective animal study. Setting: Landrace-Yorkshire pigs in a conventional laboratory setting. Intervention(s): Six female pigs underwent laparoscopic bipolar electrocoagulation of the distal uterine horns. Two weeks later, the uterine horns were reanastomosed laparoscopically with use of a robotic system for microsuturing. Necropsy was performed 4 weeks later to assess postoperative adhesions and anastomosis patency. Main Outcome Measure(s): Tubal patency; secondary measures were operative time, complications, and surgeon fatigue. Result(s): The mean (± SD) total operative time per animal was 170 ± 34 minutes including setting up and dismantling the robotic arms. The robot functioned well with only minor technical problems. All pigs survived both surgeries with no perioperative complications related to the use of the robot. Patency was confirmed after completing each anastomosis (12 anastomoses; 100% patency). Four weeks later, necropsy showed that eight anastomoses were still patent (67%). Only one pig had bilateral occlusion. Surgeon’s fatigue was mild for each animal study. Conclusion(s): Robotic technology can be used safely in creating laparoscopic microsurgical anastomoses. The robot functioned properly in a sterile operating room environment. Adequate patency rates were achieved during the acute phase and at 4-week follow-up. Robotic technology has the potential to make laparoscopic microsuturing easier.