Two-port robotic hysterectomy: a novel approach

  • Gaby N. Moawad
  • Paul Tyan
  • Elias D. Abi Khalil
Original Article

Abstract

The objective of the study was to demonstrate a novel technique for two-port robotic hysterectomy with a particular focus on the challenging portions of the procedure. The study is designed as a technical video, showing step-by-step a two-port robotic hysterectomy approach (Canadian Task Force classification level III). IRB approval was not required for this study. The benefits of minimally invasive surgery for gynecological pathology have been clearly documented in multiple studies. Patients had fewer medical and surgical complications postoperatively, better cosmesis and quality of life. Most gynecological surgeons require 3–5 ports for the standard gynecological procedure. Even though the minimally invasive multiport system provides an excellent safety profile, multiple incisions are associated with a greater risk for morbidity including infection, pain, and hernia. In the past decade, various new methods have emerged to minimize the number of ports used in gynecological surgery. The interventions employed were a two-port robotic hysterectomy, using a camera port plus one robotic arm, with a focus on salpingectomy and cuff closure. We describe a transvaginal and a transabdominal approach for salpingectomy and a novel method for cuff closure. The transvaginal and transabdominal techniques for salpingectomy for two-port robotic-assisted hysterectomy provide excellent tension and exposure for a safe procedure without the need for an extra port. We also describe a transvaginal technique to place the vaginal cuff on tension during closure. With the necessary set of skills on a carefully chosen patient, two-port robotic-assisted total laparoscopic hysterectomy is a feasible procedure.

Keywords

Robotic Hysterectomy Salpingectomy Two-port Cuff closure Novel 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Moawad is a speaker for Intuitive Surgical and Applied Medical. All other authors declare that they have no conflict of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Informed consent

Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Supplementary material

Supplementary material 1 (MP4 455406 kb)

References

  1. 1.
    Khavanin N, Mlodinow A, Milad MP, Bilimoria KY, Kim JY (2013) Comparison of perioperative outcomes in outpatient and inpatient laparoscopic hysterectomy. J Minim Invasive Gynecol 20(5):604–610CrossRefPubMedGoogle Scholar
  2. 2.
    Garry R, Fountain J, Brown J et al (2004) EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technol Assess 8(26):1–154CrossRefPubMedGoogle Scholar
  3. 3.
    Walsh CA, Walsh SR, Tang TY, Slack M (2009) Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 144(1):3–7CrossRefPubMedGoogle Scholar
  4. 4.
    Yim GW, Jung YW, Paek J et al (2010) Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes. Am J Obstet Gynecol. 203(1):26.e1–26.e6CrossRefGoogle Scholar
  5. 5.
    Goebel K, Goldberg JM (2014) Women’s preference of cosmetic results after gynecologic surgery. J Minim Invasive Gynecol 21(1):64–67CrossRefPubMedGoogle Scholar
  6. 6.
    Lee D, Kim SK, Kim K, Lee JR, Suh CS, Kim SH (2018) Advantages of single-port laparoscopic myomectomy compared with conventional laparoscopic myomectomy: a randomized controlled study. J Minim Invasive Gynecol 25(1):124–132CrossRefPubMedGoogle Scholar
  7. 7.
    Mueller ER, Kenton K, Anger JT, Bresee C, Tarnay C (2016) Cosmetic appearance of port-site scars 1 year after laparoscopic versus robotic sacrocolpopexy: a supplementary study of the ACCESS clinical trial. J Minim Invasive Gynecol 23(6):917–921CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Chaudhry Z, Tarnay CM (2017) Assessing resident surgical volume before and after initiation of a female pelvic medicine and reconstructive surgery fellowship. J Surg Educ 74(3):450–454CrossRefPubMedGoogle Scholar
  9. 9.
    Jeppson PC, Rahimi S, Gattoc L et al (2015) Impact of robotic technology on hysterectomy route and associated implications for resident education. Am J Obstet Gynecol 212(2):196.e1–196.e6CrossRefGoogle Scholar
  10. 10.
    Kenton K, Sultana C, Rogers RG, Lowenstein T, Fenner D (2008) How well are we training residents in female pelvic medicine and reconstructive surgery? Am J Obstet Gynecol 198(5):567.e1–567.e4CrossRefGoogle Scholar
  11. 11.
    Murji A, Patel VI, Leyland N, Choi M (2013) Single- incision laparoscopy in gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol 121:819–828CrossRefPubMedGoogle Scholar
  12. 12.
    Donmez T, Sunamak O, Ferahman S, Uludag SS, Yildirim D, Hut A (2016) Two-port laparoscopic appendectomy with the help of a needle grasper: better cosmetic results and fewer trocars than conventional laparoscopic appendectomy. Wideochir Inne Tech Maloinwazyjne 11(2):105–110PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Minimally Invasive Gynecologic SurgeryGeorge Washington UniversityWashington, DCUSA
  2. 2.Department of Obstetrics and GynecologyGeorge Washington UniversityWashington, DCUSA

Personalised recommendations