Robotic Gynecologic Surgery Research Articles

Current Status of Robotic Surgery in Gynecology in Japan

Current Status of Robotic Surgery in Gynecology in Japan

Port-site hernia following robotic gynecological surgery

Port-site hernia following robotic gynecological surgery

A handy reference and starter book for Robotic Gynecologic Surgery

A handy reference and starter book for Robotic Gynecologic Surgery

Mini-Laparoscopy or Single-Site Robotic Surgery in Gynecology? Let’s Think out of the Box

To date, the advancement of available technologies has led to the effective implementation of minimally invasive approaches in gynecology, with significant improvement of surgical as well as esthet...

Robotic Gynecologic Surgery: What it Means for Women

Objective: The aim of this study is to improve the understanding of the experiences of women undergoing gynecologic robotic surgery. Method: A qualitative descriptive phenomenologic approach was used. We conducted phone interviews with women who had undergone a gynecological procedure via robotic surgery in a gynecology clinic of a university hospital (n=19). Semi-structured interviews were conducted with women, and data were analyzed using Colaizzi’s methods. Results: Two major themes were identified. These two themes concerned: (1) Ambivalent Feelings on Robotic Surgery, and (2) Robotic Surgery was a Piece of Cake. Conclusion: Because of the newness of this procedure, the women in this study indicated that they had concerns and lacked information about robotic gynecologic surgery but that their decision was influenced by the confidence they had in their physicians. The women indicated that they had confidence in the robotic technique and recovered quickly physically.

Assessment of Feedback Mechanisms in Robotic Surgery Curriculum in Obstetrics and Gynecology Residency

Study Objective Overcoming the learning curve in robotic surgery requires appreciable effort. A structured curriculum in robotic gynecologic surgery was established for residents at an academic teaching hospital. This study aimed to explore resident experience with robotic surgery and training and to elicit resident preferences for feedback within the curriculum. Design A survey assessing demographics, surgical preparation methods, robotic surgical experience and comfort, and feedback preferences was distributed electronically to current obstetrics and gynecology (OB/GYN) residents. Responses were analyzed with descriptive statistics. Setting This study was conducted in the OB/GYN residency at Northwestern University in Chicago, IL. Patients or Participants The survey was sent to the 47 current OB/GYN residents in the academic year 2019-2020. A total of 29 responses were elicited. Interventions N/A Measurements and Main Results Eighteen residents (18/29; 62%) reported console experience in at least one robotic surgery. Most (26/29; 90%) stated that prior to operating on the robotic console they felt uncomfortable or very uncomfortable. Prior to console experience, residents primarily used online videos (62%), VR simulation (48%) or observation of live surgery (48%) as preparation. Of note, 7 (24%) residents reported no preparation prior to robotic surgery; these were PGY1 or PGY2 residents who also reported no prior console experience. After console experience, ongoing preparation techniques remained similar, although more residents reported in engaging in pre-operative preparation. All reported that they do receive feedback on surgical skills, but perception of usefulness, timeliness, and structure varied. Feedback was reported as useful and timely, but not well-structured. Most residents (28/29, 97%) indicated that they would prefer real-time feedback immediately after console experience. Conclusion OB/GYN residents report that they are not comfortable with robotic surgery training. Current practices for preparation include self-directed activities, but they do not begin until after surgical console experience. This study demonstrates that early initiation of structured learning with feedback is necessary.

Tips and Tricks for Adapting to Single Port Robotic Surgery

Study Objective Demonstrate ways of successfully navigating inherent limitations to the robotic single port surgical modality in the context of hysterectomy. Design Demonstration of surgical technique. Setting Academic medical center. Patients or Participants Women undergoing robotic single port surgery for benign indications. Interventions Robotic single port surgery using the SP1098 da Vinci SP® Surgical System. Measurements and Main Results The primary challenges with single port surgery are optimizing visualization and instrument mobility. The camera can be moved in a traditional fashion, or be cobra-ed, in which the camera retracts and is lifted above or below the instruments to allow for optimal utilization of space. It is best to keep the instruments as extended into the pelvis as is comfortable to allow the surgeon to engage the elbows of the instruments. Obtaining traction of tissue is limited with the single port robot. Medial traction and cephalad traction along the axis of the trocar is not restricted; however, adequate lateral or anterior traction is more challenging to obtain. The single port trocar accommodates a maximum of three instruments. However, two instruments are sufficient to achieve most surgical goals. If the fourth aperture of the trocar is not in use, a laparoscopic instrument can be inserted by the bedside assistant. Unfortunately, the assistant's mobility is greatly restricted. Movement of any laparoscopic instrument is restricted to the axis of the single port trocar. Conclusion Robotic single port gynecologic surgery is achievable with minimal adjustments to surgical technique. Optimizing visualization and instrument mobility is key for successful use of this surgical modality.

The Laparoscopic Feasibility Index: A New Approach to Formally Classifying the Difficulty of a Robotic Case

Study Objective To introduce a new method for formally classifying the difficulty of a robotic case. Design Retrospective chart review Setting Las Vegas, Nevada Patients or Participants Female patients undergoing robotic gynecologic surgery from 2005-2019 by a single gynecologic oncologist (n=1,591). Interventions N/A Measurements and Main Results A high volume gynecologic oncologist developed an index, the Laparoscopic Feasibility Index(LFI). The index had a score from one to five. A score of 1 meant the robotic case could have been done just as easily using conventional laparoscopy. A score of 5 meant the surgeon would not even attempt the case using conventional laparoscopy due to extreme challenges and a high perceived risk of conversion to open. Scores were assigned at the end of each case. We examined 1,591 robotic cases performed between 2005 and 2019. The distribution of scores were: 1(n=463, 29.1%); 2(n=313,19.7%); 3(n=345, 21.7); 4(n=231, 14.5%); 5(n=239, 15.0%). Mean console times were: 0.53hrs (score=1); 0.78hrs (score=2); 0.89hrs (score=3); 1.02hrs (score=4); 1.43hrs (score=5). Use of the 4th arm was: 8.9%(score=1); 26.6%(score=2); 37.4%(score=3); 52.6%(score=4); 89.4(score=5). Mean EBL was: 30.1cc(score=1); 45.9cc(score=2); 57.1cc(score=3); 81.1cc(score=4); and 94.5cc(score=5). All three of these trends were statistically significant. We created a regression model to predict the probability that a case had an LFI score of 5 based on EBL, use of 4th arm, and operative time. The 1591 cases were divided into 2 halves using a random number generator. The model was developed on half of the sample and coefficients applied to the other half of the sample(the validation half). The correlation between predicted and observed probabilities in the validation half of the sample was 0.98. Conclusion The Laparoscopic Feasibility Index appears to have excellent internal validity based on our analysis of over 1500 robotic cases. This index could potentially be used to monitor a surgeon's learning curve and how they progress with the complexity of their robotic cases over time.

Trends in robotic surgery in Korean gynecology

Trends in robotic surgery in Korean gynecology

Congratulations on the launch of the Robotic Gynecological Surgery journal!

Congratulations on the launch of the Robotic Gynecological Surgery journal!

Implementation of robotic gynecological surgery in a German University Hospital: patient safety after 110 procedures

PurposeRobotic surgery represents the latest development in the field of minimally invasive surgery and offers many technical advantages. Despite the higher costs, this novel approach has been applied increasingly in gynecological surgery. Regarding the implementation of a new operative method; however, the most important factor to be aware of is patient safety. In this study, we describe our experience in implementing robotic surgery in a German University Hospital focusing on patient safety after 110 procedures.MethodsWe performed a retrospective analysis of 110 consecutive robotic procedures performed in the University Hospital of Würzburg between June 2017 and September 2019. During this time, 37 patients were treated for benign general gynecological conditions, 27 patients for gynecological malignancies, and 46 patients for urogynecological conditions. We evaluated patient safety through standardized assessment of intra- and postoperative complications, which were categorized according to the Clavien–Dindo classification.ResultsNo complications were recorded in 90 (81.8%) operations. We observed Clavien–Dindo grade I complications in 8 (7.3%) cases, grade II complications in 5 (4.5%) cases, grade IIIa complications in 1 case (0.9%), and grade IIIb complications in 6 (5.5%) cases. No conversion to laparotomy or blood transfusion was needed.ConclusionRobotic surgery could be implemented for complex gynecological operations without relevant problems and was accompanied by low complication rates.

Less is more: clinical impact of decreasing pneumoperitoneum pressures during robotic surgery.

The objective of this study was to investigate the effects of decreasing insufflation pressure during robotic gynecologic surgery. The primary outcomes were patient-reported postoperative pain scores and length of stay. Secondary outcomes include surgical time, blood loss, and intraoperative respiratory parameters. This is a retrospective cohort study of patients undergoing robotic surgery for benign gynecologic conditions by a single minimally invasive surgeon at an academic hospital between 2014 and 2017. Patients were categorized by the maximum insufflation pressure reached during the surgery as either 15, 12, 10, or 8mmHg. Continuous variables were compared using analysis of variance and χ2 test was used for categorical variables. 598 patients were included in this study with no differences in age, BMI, race, prior abdominal surgeries, or specimen weight between the four cohorts. When comparing cohorts, each decrease in insufflation pressure correlated with a significant decrease in initial pain scores (5.9 vs 5.4 vs 4.4 vs. 3.8, p ≤ 0.001), and hospital length of stay (449 vs 467 vs 351 vs. 317min, p ≤ 0.001). There were no differences in duration of surgery (p = 0.31) or blood loss (p = 0.09). Lower operating pressures were correlated with significantly lower peak inspiratory pressures (p < 0.001) and tidal volumes (p < 0.001). Surgery performed at lower-pressure pneumoperitoneum (≤ 10mmHg) is associated with lower postoperative pain scores, shorter length of stay, and improved intraoperative respiratory parameters without increased duration of surgery or blood loss. Operating at lower insufflation pressures is a low-cost, reversible intervention that should be implemented during robotic surgery as it results in the improved pain scores and shorter hospital stays.

Asian Society for Gynecologic Robotic Surgery consensus guidelines on robotic surgery in gynecological cancer

Asian Society for Gynecologic Robotic Surgery consensus guidelines on robotic surgery in gynecological cancer

The development of a robotic gynaecological surgery training curriculum and results of a delphi study

BackgroundTechnology for minimal access surgery is rapidly progressing in all surgical specialities including Gynaecology. As robotic surgery becomes established in increasing numbers of hospitals, there is no set curriculum for training in robotic gynaecological surgery or the assistant role in use in the UK. The purpose of this study was to determine a list of competencies that could be used as the basis of a core robotic gynaecological surgery curriculum, to explore its acceptability and the level of interest in undertaking training in robotics among obstetrics & gynaecology (O&G) trainees.MethodsA four-round Delphi study was conducted using members and associates of British & Irish Association of Robotic Gynaecological Surgeons (BIARGS). In Round 1 respondents were asked to propose standards that could be used in the curriculum. In the following three rounds, the respondents were asked to score each of the standards according to their opinion as to the importance of the standard. Items that scored a mean of 80% or above were included in the final proposed curriculum. Following this, a national survey was conducted to explore the interest among O&G trainees in undertaking a formal robotic training for the first assistant and console surgeon roles.ResultsThe items proposed were divided into three separate sections: competencies for a medical first assistant; competencies for a console surgeon; continued professional development for trained console surgeons. From the national survey; 109 responses were received of which 60% were interested in undertaking a formal training for the first assistant role, and 68% are expressing interest in training for the console surgeon role.ConclusionUndertaking a Delphi exercise to determine a core gynaecological robotic training curriculum has enabled consensus to be achieved from the opinions of BIARGS members/associates. There is interest among O&G trainees at all levels of training to gain experience and develop their skills in robotic surgery by undertaking a formal training in robotic surgery at both the first assistant and console surgeon level.

Robotic surgery in gynecology: review of literature.

Robotic surgery carries with it the potential to transform laparoscopic surgery by providing, for the 1st time, instruments with distal ends that mimic the intricate movements of the human hand while at the same time providing the surgeon with a high-definition, three-dimensional view of the operative field. To describe the clinical application of robotic surgery in benign gynecological conditions, as well as the components of the Da Vinci Si robotic system, analyzing the advantages and disadvantages of this type of surgical approach that it provides to the patient and in turn to the surgeon. Review of the literature in PubMed and UpToDate where the keywords of our review were searched. Inclusion criteria: Articles of cases or series containing the sections of the application of robotic surgery in gynecology and clinical results. We found 50 scientific articles that included in their titles the key words of our review. 22 articles were discarded, 14 because they were inaccessible, 3 because they were published in bulletins without an impact factor and 5 because no information was obtained about the researcher's results, their volume, visibility and structure. A total of 28 articles were chosen for this review. Robotic surgery has evolved to be a separate field, with enormous potential for future development. The results show until now that this technology is applicable and capable of offering an adequate treatment to selected patients.

A New Silicon Sling Device for Traction During Robotic Gynecologic Surgery.

Background:One of the challenges of robotic gynecologic surgery is the appropriate traction of the organs and other structures surrounding the surgical field.Methods:We developed a novel traction device, VESOPASTA, that can be used for organ traction during robotic gynecologic surgery. This study describes the utility and the safety of the use of VESOPASTA for ureteral traction during robotic-assisted laparoscopic radical hysterectomy in five cervical cancer patients.Results:Ureteral suspension was successfully and safely performed using VESOPASTA during robotic-assisted laparoscopic radical hysterectomy in cervical cancer patients without causing any complications. The average time required for this procedure was less than 5 min.Conclusions:We have developed a novel device, VESOPASTA, which can be used for organ traction during robotic surgery. This new device allows easy ureteral traction, facilitate the identification of ureter and prevent ureteral injuries during robotic-assisted laparoscopic radical hysterectomy.

Robot assisted surgery during the COVID-19 pandemic, especially for gynecological cancer: a statement of the Society of European Robotic Gynaecological Surgery (SERGS).

All surgery performed in an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, irrespective of the known or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) status of the patient, should be regarded as high risk and protection of the surgical team at the bedside should be at the highest level. Robot assisted surgery (RAS) may help to reduce hospital stay for patients that urgently need complex-oncological-surgery, thus making room for COVID-19 patients. In comparison to open or conventional laparoscopic surgery, RAS potentially reduces not only contamination with body fluids and surgical gasses of the surgical area but also the number of directly exposed medical staff. A prerequisite is that general surgical precautions under COVID-19 circumstances must be taken, with the addition of prevention of gas leakage: • Use highest protection level III for bedside assistant, but level II for console surgeon.• Reduce the number of staff at the operation room.• Ensure safe and effective gas evacuation.• Reduce the intra-abdominal pressure to 8 mmHg or below.• Minimize electrocautery power and avoid use of ultrasonic sealing devices.• Surgeons should avoid contact outside theater (both in and out of the hospital).

Safety and efficacy of contained manual morcellation during laparoscopic or robotic gynecological surgery.

To assess the safety and efficacy of contained manual morcellation (CMM) with a tissue pouch during minimally invasive robotic or laparoscopic surgeries. A retrospective cohort study included women who underwent robotic or laparoendoscopic single-site surgery at a tertiary referral center between February 2014 and April 2017. The specimen was postoperatively contained, sliced into one or more long strips, and then pulled out. The surgical type, specimen containment time, containment failure rate, specimen weight, manual morcellation time, and overall CMM speed (g/min) were recorded. Surgical complications related (bowel or bladder injury, ureteral injury, vascular injuries, and tumor dissemination) or not related (delayed wound healing, infection, and hernia) to CMM were also documented. The patients were followed up for 2years. A total of 165 cases were recorded, comprising 149 cases that underwent laparoscopic and 16 that underwent robotic gynecological surgeries. The average time for specimen containment and manual morcellation in CMM was 6.7±5.0 and 13.2±11.2min, respectively. The mean morcellation speed was 25.1±8.5g/min. Among the specimens, those of the uterus with adenomyosis had the lowest CMM speed (21.4±8.0g/min), whereas those of the uterus with myoma had the highest speed (27.5±8.9g/min). The pouch perforation rate after CMM was 13.3% and no pouch-related complication was noted. CMM is an efficient method for specimen removal.

Mortality Rates in Laparoscopic and Robotic Benign Gynecologic Surgery- A Systemic Review and Meta-Analysis

Study Objective review mortality rates in benign gynecologic laparoscopic and robotic surgery (MIS), and to evaluate the mortality rates associated with commonly performed MIS procedures. Design Meta-analysis. Setting NA Patients or Participants An electronic-based search was performed on Pubmed, Embase, Scopus, Web of Science, and Cochrane Database. All MIS studies in benign gynecology reporting operative mortality (within 30 days) were reviewed. Meta-analysis was applied to calculate pooled mortality rates using the inverse-variance method. The relative risks (RRs) and their corresponding 95% confidence intervals (95% CIs) were calculated using the Mantel-Haenszel method. Interventions Meta-analysis. Measurements and Main Results 21 articles (12,5738 patients) were included. Operative mortality from any benign MIS (laparoscopy and robotics) procedure was 1:4243 (95% CI 1:1573- 1:11450). Studies were then grouped based on surgical procedure. Mortality rate for hysterectomy (43,112 patients) was 1:4920 (95% CI 1:2233, 1:10845); for sacrocolpopexy was 1:1246 (95% CI 1:36, 1:44700); and for adnexal surgery and diagnostic laparoscopy was 1:2245 (95% CI 1:45, 1:113372). Seventeen studies reported operative mortality for laparoscopic surgery, and 4 for robotic surgery. Conclusion Operative mortality in benign minimally invasive gynecologic surgery is low. There is no major difference for laparoscopic and robotic approaches.

Incidence of Post-Up Urinary Tract Infections After Routine Cystoscopy in Minimally Invasive Robotic Gynecologic Surgery

Study Objective The aim of this study is to investigate the incidence of post-op urinary tract infections (UTIs) after routine cystoscopy in robotic-assisted gynecologic surgery and to compare the rate to reported incidence of similar gynecologic surgeries without the use of routine cystoscopy. Design Retrospective study utilizing a single gynecologic oncologist database (July 1, 2017 to March 30, 2019) in which routine cystoscopy was performed to detect urinary tract injury following robotic total hysterectomies (RTH) for surgical treatment of benign and malignant pathologies (N= 151). Data was analyzed using Chi-square test, unpaired t-test, and bivariate correlation. Setting Patients were in low lithotomy, Trendelenburg position for enhanced manipulation of uterus. Patients or Participants 151 patients underwent robotic total hysterectomy with bilateral salpingo-oophorectomy and total pelvic lymphadenectomy, after which a cystoscopy was performed to evaluate integrity of ureteral function and any bladder injury. Interventions Routine cystoscopy after surgery. Measurements and Main Results Routine cystoscopy did not find urinary tract injuries in any of the patients. Out of 151 patients, 21 (13.9%) has post-op UTIs within 30 days of routine cystoscopy. Patients with post-op UTIs had higher median operating room time, younger age, more complex surgeries, and higher estimated blood loss (EBL) (Table 1). Patients with a post-op UTI had a higher incidence of a malignant post-op diagnosis. Increased incidence of post-op UTIs were also statistically significantly associated with longer surgery duration, p Conclusion Younger patients with an increased EBL and longer surgeries were associated with a higher rate of post-op UTI after routine cystoscopy in robotic-assisted gynecologic surgery. UTI's are common in women undergoing gynecologic surgery; however, the rate appears to be higher with routine cystoscopy in this small cohort. Consideration of a larger sample size merits further investigation.