Two-Port Robotic Laparoscopic Hysterectomy

Abstract

<h3>Study Objective</h3> To demonstrate a surgical video wherein a technique for port-reducing robot-assisted laparoscopic hysterectomy was performed with the use of a gel-capped multi-trocar port that accommodates necessary instruments to safely complete the procedure. <h3>Design</h3> Case report, step-by-step video describing a port-reducing robot-assisted laparoscopic hysterectomy with the gel-capped multi-trocar port. Institutional Review Board (IRB) approval was not required. <h3>Setting</h3> Tertiary referral medical center in New Haven, Connecticut. A 40-year-old female with symptomatic uterine leiomyoma who underwent failed medical management. She has completed her childbearing. Her body mass index was 41 kg/m². A pelvic sonogram showed a 10-centimeter uterus with a 10-centimeter fibroid. On examination, her uterus was mobile. <h3>Patients or Participants</h3> Singular patient who consented for this demonstration video. <h3>Interventions</h3> The patient underwent an uncomplicated robotically assisted total laparoscopic hysterectomy and bilateral salpingectomy. This was accomplished using a two-port technique. A multi-channel port system and a second robotic trocar were used. <h3>Measurements and Main Results</h3> Effective dissection of the adnexal structures and ligaments of the uterus was accomplished. Isolation, coagulation, and transection of blood vessels was optimally done with the vessel sealer. Despite the size of the uterus and leiomyoma, the specimen was completely removed transvaginally, without morcellation. Vaginal cuff closure was done with delayed absorbable barbed suture with ease. The three-centimeter fascial incision was re-approximated. There were no intra-operative complications. Estimated blood loss was 150 ml. She was discharged home on the same day. Her final histopathology was benign. <h3>Conclusion</h3> The two-port robotic hysterectomy with the gel-capped multi-channel laparoscopic port afforded the use of additional necessary laparoscopic instruments to safely complete the procedure while avoiding the usual three to five port incisions most gynecological surgeons use. This approach utilized the advantages of robotic laparoscopy: superior operative visualization, improved instrument mechanics and stabilization, and upgraded ergonomics for the surgeon. Our robotic hysterectomy technique is a feasible alternative for the appropriately selected patients.