Abstract
To investigate the development of new technical approaches for improving the implementation of robotics in gynaecologic surgery, we conducted a prospective evaluation of five technical modifications developed during the implementation of a robotics program that included 171 robotic endometrial staging procedures from December 2007 until May 2010. Modification of the use of a Hohl uterine manipulator by applying only the intravaginal component minimizes the theoretical risk of spillage of endometrial cancer cells, without losing the capability of delineating the vaginal fornices. Entry to the peritoneal cavity under visual control using a left upper quadrant approach and a 5-mm endoscope through a 5-mm Endopath® trocar is quick and decreases the risk of bowel or vessel injury. Use of 12-mm Endopath® trocars with blunt tips without closure of the fascia was not associated with post-operative hernias. Positioning the Da Vinci® Surgical System at a 30° angle at the side of the patient allows easy access to the vagina for removal of large surgical specimens and does not interfere with proper movements of the robotic arms. Use of a tissue specimen bag introduced via the vagina at completion of surgery allows removal of large uteri vaginally to avoid (mini-)laparotomy and its morbidities. Finally, suturing of the vault using interrupted delayed absorbable monofilament sutures was not associated with vaginal cuff dehiscence. Early evaluation of evolving minor technical and surgical approaches was associated with low morbidity, and appears to benefit patients undergoing robotic surgery for gynaecologic cancers.
Similar content being viewed by others
References
Satava RM (2002) Surgical robotics: the early chronicles: a personal historical perspective. Surg Laparosc Endosc Percutan Tech 12:6–16
Shafer A, Boggess JF (2008) Robotic-assisted endometrial cancer staging and radical hysterectomy with the da Vinci surgical system. Gynecol Oncol 111:S18–S23
Eltabbakh GH, Mount SL (2006) Laparoscopic surgery does not increase the positive peritoneal cytology among women with endometrial carcinoma. Gynecol Oncol 100:361–364
Lim S, Kim HS, Lee KB, Yoo CW, Park SY, Seo SS (2008) Does the use of a uterine manipulator with an intrauterine balloon in total laparoscopic hysterectomy facilitate tumor cell spillage into the peritoneal cavity in patients with endometrial cancer? Int J Gynecol Cancer 18:1145–1149
Polyzos NP, Mauri D, Tsioras S, Messini CI, Valachis A, Messinis IE (2010) Intraperitoneal dissemination of endometrial cancer cells after hysteroscopy: a systematic review and meta-analysis. Int J Gynecol Cancer 20:261–267
Vilos GA, Ternamian A, Dempster J, Laberge PY, The Society of Obstetricians and Gynaecologists of Canada (2007) Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can 29(5):433–465
Ahmad G, Duffy JM, Phillips K, Watson A (2008) Laparoscopic entry techniques. Cochrane Database Syst Rev 2:CD006583
Shaher Z (2007) Port closure techniques. Surg Endosc 21:1264–1274
Hotston MR, Beatty JD, Shendi K, Ogden C (2000) Port site hernias following robot-assisted laparoscopic prostatectomy. J.Robotic Surg 3:49–51
Liu CD, McFadden DW (2000) Laparoscopic port sites do not require fascial closure when nonbladed trocars are used 66:853–854
Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, Fowler WC (2008) A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol 199:360–369
Cardenas-Goicoechea J, Adams S, Bhat SB, Randall TC (2010) Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center. Gynecol Oncol 117:224–228
Hur HC, Guido RS, Mansuria SM, Hacker MR, Sanfilippo JS, Lee TT (2007) Incidence and patient characteristics of vaginal cuff dehiscence after different modes of hysterectomies. J Minim Invasive Gynecol 14:311–317
Iaco PD, Ceccaroni M, Alboni C, Roset B, Sansovini M, D’Alessandro L, Pignotti E, Aloysio DD (2006) Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk? Eur J Obstet Gynecol Reprod Biol 125:134–138
Robinson BL, Liao JB, Adams SF, Randall TC (2009) Vaginal cuff dehiscence after robotic total laparoscopic hysterectomy. Obstet Gynecol 114:369–371
Agdi M, Al-Ghafri W, Antolin R, Arrington J, O’Kelley K, Thomson AJ, Tulandi T (2009) Vaginal vault dehiscence after hysterectomy. J Minim Invasive Gynecol 16:313–317
Acknowledgments
This work was supported by grants from the Israel Cancer Research Foundation, the Norych Career Scientist Award, the Schouella Distinguished Scientist Award, the Greenbaum Fund, Gloria’s Girl Fund, Friends for Life, and the Turqwise Fund.
Conflict of interest
W.H.G. has served as a proctor for robotics in Canada, China, and Israel.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Peeters, F., Vaknin, Z., Lau, S. et al. Technical modifications in the robotic-assisted surgical approach for gynaecologic operations. J Robotic Surg 4, 253–257 (2010). https://doi.org/10.1007/s11701-010-0223-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-010-0223-x