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The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference

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Abstract

Background

Despite the significant benefits of laparoscopic surgery, limitations still exist. One of these limitations is the loss of several degrees of freedom. Robotic surgery has allowed surgeons to regain the two lost degrees of freedom by introducing wristed laparoscopic instruments.

Methods

At the first Pelvic Surgery Meeting held in Brescia in June 2007, the participants focused on the role of robotic surgery in pelvic operations surgery for malignancy including prostate, rectal, uterine, and cervical carcinoma. All members of the interdisciplinary panel were asked to define the role of robotic surgery in prostate, rectal, and uterine carcinoma. All key statements were reformulated until a consensus within the group was achieved (Murphy et al., Health Technol Assess 2(i–v):1–88, 1998). For the systematic review, a comprehensive literature search was performed in Medline and the Cochrane Library from January 1997 to June 2007. The keywords used were Da Vinci®, telemonitoring, laparoscopy, neoplasms for urology, colorectal, gynecology, visceral surgery, and minimally invasive surgery. The pelvic surgery meeting was supported by Olympus Medical Systems Europa.

Results

As of December 31, 2007, there were 795 unit shipments worldwide of the Da Vinci®: 595 in North America, 136 in Europe, and 64 in the rest of the world (http://investor.intuitivesurgical.com/phoenix.zhtml?c=122359&p=irol-faq#22324). It was estimated that, during 2007, approximately 50,000 radical prostatectomies were performed with the Da Vinci® robot system in the USA, reflecting market penetration of 60% of radical prostatectomies in the USA. This utilization represents 50% growth as in 2006 only 42% of all radical prostatectomies performed in the USA employed robotics.

Conclusion

While robotic prostatectomy has become the most widely accepted method of prostatectomy, robotic hysterectomy and proctectomy remain far less widely accepted. The theoretical benefits of the increased degrees of freedom and three-dimensional visualization may be outweighed in these areas by the loss of haptic feedback, increased operative times, and increased cost.

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References

  1. Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CFB, Askham J, Marteau T (1998) Consensus development methods, and their use in clinical guideline development. Health Technol Assess 2(i–v):1–88

    Google Scholar 

  2. Wiklund NP (2004) Technology Insight: surgical robots—expensive toys or the future of urologic surgery? Nat Clin Pract Urol 1:97–102

    Article  PubMed  Google Scholar 

  3. Abdelshehid CS, Eichel L, Lee D, Uribe C, Boker J, Basillote J, McDougall EM, Clayman RV, Winfield HN, Gill IS et al (2005) Current trends in urologic laparoscopic surgery. J Endourol 19:15–20

    Article  PubMed  Google Scholar 

  4. Dasgupta P, Hemal A, Rose K (2005) Robotic urology in the UK: establishing a programme and emerging role. BJU Int 95:723–724

    Article  PubMed  Google Scholar 

  5. Kallstrom R, Hjertberg H, Kjolhede H, Svanvik J (2005) Use of a virtual reality, real-time, simulation model for the training of urologists in transurethral resection of the prostate. Scand J Urol Nephrol 39:313–320

    Article  PubMed  Google Scholar 

  6. Kaul S, Menon M (2005) Robotics in laparoscopic urology. Minim Invasive Ther Allied Technol 14:62–70

    Article  PubMed  CAS  Google Scholar 

  7. McLeod IK, Melder PC (2005) Da Vinci® robot-assisted excision of a vallecular cyst: a case report. Ear Nose Throat J 84:170–172

    PubMed  Google Scholar 

  8. Nedas TG, Challacombe BJ, Dasgupta P (2005) Robotics in urology: an update. Int J Med Robot 1:13–18

    PubMed  CAS  Google Scholar 

  9. Pott PP, Scharf HP, Schwarz ML (2005) Today’s state of the art in surgical robotics. Comput Aided Surg 10:101–132

    Article  PubMed  Google Scholar 

  10. Rassweiler J, Safi KC, Subotic S, Teber D, Frede T (2005) Robotics and telesurgery—an update on their position in laparoscopic radical prostatectomy. Minim Invasive Ther Allied Technol 14:109–122

    Article  PubMed  CAS  Google Scholar 

  11. Schiff J, Li PS, Goldstein M (2005) Robotic microsurgical vasovasostomy and vasoepididymostomy in rats. Int J Med Robot 1:122–126

    PubMed  CAS  Google Scholar 

  12. Varkarakis IM, Rais-Bahrami S, Kavoussi LR, Stoianovici D (2005) Robotic surgery and telesurgery in urology. Urology 65:840–846

    Article  PubMed  Google Scholar 

  13. Atug F, Castle EP, Woods M, Davis R, Thomas R (2006) Robotics in urologic surgery: an evolving new technology. Int J Urol 13:857–863

    Article  PubMed  Google Scholar 

  14. Badani KK, Hemal AK, Peabody JO, Menon M (2006) Robotic radical prostatectomy: the Vattikuti Urology Institute training experience. World J Urol 24:148–151

    Article  PubMed  Google Scholar 

  15. Challacombe B, Kavoussi L, Patriciu A, Stoianovici D, Dasgupta P (2006) Technology insight: telementoring and telesurgery in urology. Nat Clin Pract Urol 3:611–617

    Article  PubMed  Google Scholar 

  16. Challacombe BJ, Khan MS, Murphy D, Dasgupta P (2006) The history of robotics in urology. World J Urol 24:120–127

    Article  PubMed  Google Scholar 

  17. Chin JL (2006) From retrograde pyelography to robotic prostatectomy: history of urology at the University of Western Ontario. Can J Urol 13:2949–2952

    PubMed  Google Scholar 

  18. Dasgupta P, Challacombe B, Murphy D, Khan MS (2006) Coming full circle in robotic urology. BJU Int 98:4–5

    Article  PubMed  Google Scholar 

  19. Duchene DA, Moinzadeh A, Gill IS, Clayman RV, Winfield HN (2006) Survey of residency training in laparoscopic and robotic surgery. J Urol 176:2158–2166 (discussion 2167)

    Article  PubMed  Google Scholar 

  20. Elliott DS, Chow GK, Gettman M (2006) Current status of robotics in female urology and gynecology. World J Urol 24:188–192

    Article  PubMed  Google Scholar 

  21. Kaul S, Menon M (2006) Robotic radical prostatectomy: evolution from conventional to VIP. World J Urol 24:152–160

    Article  PubMed  Google Scholar 

  22. Kommu SS, Patel SP (2006) The stilus (surgical trainees interested in laparoscopic and robotic urological surgery) group. BJU Int 98:233

    Article  PubMed  Google Scholar 

  23. Laguna MP, de Reijke TM, Wijkstra H, de la Rosette J (2006) Training in laparoscopic urology. Curr Opin Urol 16:65–70

    Article  PubMed  Google Scholar 

  24. Lee RS, Borer JG (2006) Robotic surgery for ureteropelvic junction obstruction. Curr Opin Urol 16:291–294

    Article  PubMed  Google Scholar 

  25. Long JA, Descotes JL, Skowron O, Troccaz J, Cinquin P, Boillot B, Terrier N, Rambeaud JJ (2006) Use of robotics in laparoscopic urological surgery: state of the art. Prog Urol 16:3–11

    PubMed  Google Scholar 

  26. McDougall EM, Corica FA, Chou DS, Abdelshehid CS, Uribe CA, Stoliar G et al (2006) Short-term impact of a robot-assisted laparoscopic prostatectomy ‘mini-residency’ experience on postgraduate urologists’ practice patterns. Int J Med Robot 2:70–74

    PubMed  Google Scholar 

  27. Moran ME (2006) The da Vinci® robot. J Endourol 20:986–990

    Article  PubMed  Google Scholar 

  28. Muntener M, Ursu D, Patriciu A, Petrisor D, Stoianovici D (2006) Robotic prostate surgery. Expert Rev Med Devices 3:575–584

    Article  PubMed  Google Scholar 

  29. Murphy D, Challacombe B, Khan MS, Dasgupta P (2006) Robotic technology in urology. Postgrad Med J 82:743–747

    Article  PubMed  CAS  Google Scholar 

  30. Nezhat C, Saberi NS, Shahmohamady B, Nezhat F (2006) Robotic-assisted laparoscopy in gynecological surgery. JSLS 10:317–320

    PubMed  Google Scholar 

  31. Patel VR (2006) Essential elements to the establishment and design of a successful robotic surgery programme. Int J Med Robot 2:28–35

    PubMed  Google Scholar 

  32. Perrotti M, Badger W, Prader S, Moran ME (2006) Medical malpractice in urology, 1985 to 2004: 469 consecutive cases closed with indemnity payment. J Urol 176:2154–2157 (discussion 2157)

    Article  PubMed  Google Scholar 

  33. Rashid HH, Leung YY, Rashid MJ, Oleyourryk G, Valvo JR, Eichel L (2006) Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy. Urology 68:75–79

    Article  PubMed  Google Scholar 

  34. Sahabudin RM, Arni T, Ashani N, Arumuga K, Rajenthran S, Murali S, Patel V, Hemal A, Menon M (2006) Development of robotic program: an Asian experience. World J Urol 24:161–164

    Article  PubMed  CAS  Google Scholar 

  35. Shalhav AL, Orvieto MA, Chien GW, Mikhail AA, Zagaja GP, Zorn KC (2006) Minimizing knot tying during reconstructive laparoscopic urology. Urology 68:508–513

    Article  PubMed  Google Scholar 

  36. Tewari A, Takenaka A, Mtui E, Horninger W, Peschel R, Bartsch G, Vaughan ED (2006) The proximal neurovascular plate and the tri-zonal neural architecture around the prostate gland: importance in the athermal robotic technique of nerve-sparing prostatectomy. BJU Int 98:314–323

    Article  PubMed  Google Scholar 

  37. Villavicencio Mavrich H (2006) Da Vinci® advanced robotic laparoscopic surgery: origin and current clinical application in urology, and comparison with open and laparoscopic surgery. Actas Urol Esp 30:1–12

    Article  PubMed  CAS  Google Scholar 

  38. Albani JM (2007) The role of robotics in surgery: a review. Mo Med 104:166–172

    PubMed  Google Scholar 

  39. Aron M, Haber GP, Desai MM, Gill IS (2007) Flexible robotics: a new paradigm. Curr Opin Urol 17:151–155

    Article  PubMed  Google Scholar 

  40. Descazeaud A, Peyromaure M, Zerbib M (2007) Will robotic surgery become the gold standard for radical prostatectomy? Eur Urol 51:9–11

    Article  PubMed  Google Scholar 

  41. Frede T, Jaspers J, Hammady A, Lesch J, Teber D, Rassweiler J (2007) Robotics and telemanipulation: update and perspectives in urology. Minerva Urol Nefrol 59:179–189

    PubMed  CAS  Google Scholar 

  42. O’Malley SP, Jordan E (2007) Review of a decision by the Medical Services Advisory Committee based on health technology assessment of an emerging technology: the case for remotely assisted radical prostatectomy. Int J Technol Assess Health Care 23:286–291

    PubMed  Google Scholar 

  43. Park S, Bergs RA, Eberhart R, Baker L, Fernandez R, Cadeddu JA (2007) Trocar-less instrumentation for laparoscopy: magnetic positioning of intra-abdominal camera and retractor. Ann Surg 245:379–384

    Article  PubMed  Google Scholar 

  44. Taylor GW (2007) Developing technology for surgery in the UK: a multidisciplinary meeting of engineers and surgeons. Int J Med Robot 3:30–34

    PubMed  CAS  Google Scholar 

  45. http://investor.intuitivesurgical.com/phoenix.zhtml?c=122359&p=irol-faq#22324

  46. Patel VR, Thaly R, Shah K (2007) Robotic radical prostatectomy: outcomes of 500 cases. BJU Int 99:109–112

    Google Scholar 

  47. Badani KK, Kaul S, Menon M (2007) Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 110:1951–1958

    Article  PubMed  Google Scholar 

  48. Schwentner C, Pelzer A, Neururer R, Springer B, Horninger W, Bartsch G, Peschel R (2007) Robotic Anderson-Hynes pyeloplasty: 5-year experience of one centre. BJU Int 100:880–885

    Article  PubMed  Google Scholar 

  49. Rogers CG, Singh A, Blatt AM, Linehan WM, Pinto PA (2008) Robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol 53:514–521

    Article  PubMed  Google Scholar 

  50. Kane CJ (2008) Laparoscopic radical cystectomy for cancer; oncologic outcomes for up to 5 years Haber GP, Gill IS, Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, OH. Urol Oncol 26:221

    Google Scholar 

  51. Rhee JJ, Lebeau S, Smolkin M, Theodorescu D (2006) Radical cystectomy with ileal conduit diversion: early prospective evaluation of the impact of robotic assistance. BJU Int 98:1059–1063

    Article  PubMed  Google Scholar 

  52. Myer EG, Wagner JR (2007) Robotic assisted laparoscopic bladder diverticulectomy. J Urol 178:2406–2410 (discussion 2410)

    Article  PubMed  Google Scholar 

  53. Sotelo R, Clavijo R, Carmona O, Garcia A, Banda E, Miranda M, Fagin R (2008) Robotic simple prostatectomy. J Urol 179:513–515

    Article  PubMed  Google Scholar 

  54. John H, Wiklund P (eds) (2008) Robotic urology. Springer, Berlin

    Google Scholar 

  55. Breukink S, Pierie J, Wiggers T (2006) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 18(4):CD005200

    Google Scholar 

  56. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192

    Article  PubMed  Google Scholar 

  57. Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13:413–424

    Article  PubMed  Google Scholar 

  58. Pigazzi A, Ellenhorn JDI, Ballantyne GH, Paz IB (2006) Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc 20:1521–1525

    Article  PubMed  CAS  Google Scholar 

  59. Hellen M, Anderson C, Ellhorn JDI, Paz B, Pigazzi A (2007) Short-term outcomes after robotic-assisted total mesorectal excision for rectal cancer. Ann Surg Oncol 14:3168–3173

    Article  Google Scholar 

  60. Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46:1633–1639

    Article  PubMed  Google Scholar 

  61. Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C Jr (2002) Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc 16:1271–1273

    Article  PubMed  CAS  Google Scholar 

  62. Linderoth HC (2002) Managing telemedicine: from noble ideas to action. J Telemed Telecare 8:143–150

    Article  PubMed  Google Scholar 

  63. Falcone T, Goldberg JM (2003) Robotics in gynecology. Surg Clin North Am 83:1483–1489, xii

    Google Scholar 

  64. Macedonia CR, Gherman RB, Satin AJ (2003) Simulation laboratories for training in obstetrics and gynecology. Obstet Gynecol 102:388–392

    Article  PubMed  Google Scholar 

  65. Gallagher AG, Cates CU (2004) Virtual reality training for the operating room and cardiac catheterisation laboratory. Lancet 364:1538–1540

    Article  PubMed  Google Scholar 

  66. McLeod IK, Melder PC (2005) Da Vinci® robot-assisted excision of a vallecular cyst: a case report. Ear Nose Throat J 84:170–172

    PubMed  Google Scholar 

  67. Senapati S, Advincula AP (2005) Telemedicine and robotics: paving the way to the globalization of surgery. Int J Gynaecol Obstet 91:210–216

    Article  PubMed  CAS  Google Scholar 

  68. Dickens BM, Cook RJ (2006) Legal and ethical issues in telemedicine and robotics. Int J Gynaecol Obstet 94:73–78

    Article  PubMed  CAS  Google Scholar 

  69. Elliott DS, Chow GK, Gettman M (2006) Current status of robotics in female urology and gynecology. World J Urol 24:188–192

    Article  PubMed  Google Scholar 

  70. Fiorentino RP, Zepeda MA, Goldstein BH, John CR, Rettenmaier MA (2006) Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes. J Minim Invasive Gynecol 13:60–63

    Article  PubMed  Google Scholar 

  71. Jude DC, Gilbert GG, Magrane D (2006) Simulation training in the obstetrics and gynecology clerkship. Am J Obstet Gynecol 195:1489–1492

    PubMed  Google Scholar 

  72. Nezhat C, Saberi NS, Shahmohamady B, Nezhat F (2006) Robotic-assisted laparoscopy in gynecological surgery. JSLS 10:317–320

    PubMed  Google Scholar 

  73. Bocca S, Stadtmauer L, Oehninger S (2007) Uncomplicated full term pregnancy after da Vinci®-assisted laparoscopic myomectomy. Reprod Biomed Online 14:246–249

    Article  PubMed  Google Scholar 

  74. Holub Z (2007) Robot-assisted laparoscopic surgery in gynecology: scientific dream or reality? Ceska Gynekol 72:3–4

    PubMed  CAS  Google Scholar 

  75. Magrina JF (2007) Robotic surgery in gynecology. Eur J Gynaecol Oncol 28:77–82

    PubMed  CAS  Google Scholar 

  76. Huirne JA, Kennedy R, Stolzenberg J, Brolmann HA (2008) What is the impact of surgical expertise and how to get it? Gynecol Surg

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Acknowledgements

The authors would like to acknowledge the additional members of the Robotic Consensus Group: Dr. Clément Claude, Dr. Abbou, Dr. Günter Janetschek, Dr. Adrian Joyce, Dr. Paolo Puppo, Dr. Jens-Uwe Stolzenburg, Dr. Ben Van Cleynenbreugel, Dr. Stephanie Berdah, Dr. Eiji Kanehira, Dr. Ferdinand Kockerling, Dr. Lukas Krähenbühl, Dr. Luca Minelli, Dr. Michael Abou-Dakn, Dr. Francisco Carmona, Dr. Mordechai Goldenberg, Dr. Michael Hohl, Dr. Andrew Kent, Dr. Marc Possover, Dr. Giovanni Scambia, and Dr. Roberto Tozzi.

Disclosures:

Steven D Wexner M.D. has stock options in intuitive surgical for work done as a consultant for Computer Motion, Inc. The pelvic surgery meeting was supported by ‘Olympus Medical Systems Europa GmbH Hamburg, Germany'.

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Wexner, S.D., Bergamaschi, R., Lacy, A. et al. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc 23, 438–443 (2009). https://doi.org/10.1007/s00464-008-0202-8

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  • DOI: https://doi.org/10.1007/s00464-008-0202-8

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