Abstract
This study aimed to assess the status of abdominal wall adhesions resulting from prior surgeries and their impact on the outcomes of robotic surgery. We retrospectively reviewed clinical information, surgical outcomes, and the status of abdominal wall adhesions in patients who underwent gynecologic robotic surgery at Yamanashi Central Hospital, between April 2018 and March 2023. Abdominal wall adhesions were classified into seven locations and their presence was assessed at each site. Among the 768 cases examined, 196 showed the presence of abdominal wall adhesions. Notably, patients with a history of abdominal surgery exhibited a significantly higher incidence of abdominal wall adhesions than those without such surgical history, although no significant difference was observed in the frequency of adhesions in the upper left abdomen. Patients with a history of gynecologic, gastrointestinal, or biliopancreatic surgeries were more likely to have adhesions at the umbilicus or upper abdomen sites where trocars are typically inserted during robotic surgery. Although cases with abdominal wall adhesions experienced longer operative times than those without, there was no significant difference in estimated blood loss. In 13 cases (1.7%), adjustments in trocar placement were necessary due to abdominal wall adhesions, although none of the cases required conversion to open or conventional laparoscopic surgery. Abdominal wall adhesions pose challenges to minimally invasive procedures, emphasizing the importance of predicting these adhesions based on a patient’s surgical history to safely perform robotic surgery. These results suggest that the robot’s flexibility proves effective in managing abdominal wall adhesions.
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No datasets were generated or analysed during the current study.
References
Marchand G, Taher Masoud A, Ware K et al (2021) Systematic review and meta-analysis of all randomized controlled trials comparing gynecologic laparoscopic procedures with and without robotic assistance. Eur J Obstet Gynecol Reprod Biol 265:30–38. https://doi.org/10.1016/j.ejogrb.2021.07.038
Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ (2006) Laparoscopic lysis of adhesions. World J Surg 30:535–540. https://doi.org/10.1007/s00268-005-7778-0
Palmer R (1974) Safety in laparoscopy. J Reprod Med 13:1–5
Jain N, Srivastava S, Bayya SLP, Jain V (2022) Jain point laparoscopic entry in contraindications of Palmers point. Front Surg. https://doi.org/10.3389/fsurg.2022.928081
Lönnerfors C, Persson J (2013) Implementation and applications of robotic surgery within gynecologic oncology and gynecology; analysis of the first thousand cases. Ceska Gynekol 78:12–19
Cusimano MC, Simpson AN, Dossa F et al (2019) Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: a systematic review and meta-analysis of conversions and complications. Am J Obstet Gynecol 221:410–428. https://doi.org/10.1016/j.ajog.2019.05.004
Jones N, Fleming ND, Nick AM et al (2014) Conversion from robotic surgery to laparotomy: a case-control study evaluating risk factors for conversion. Gynecol Oncol 134:238–242. https://doi.org/10.1016/j.ygyno.2014.06.008
Advincula AP, Song A (2007) The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol 19:331–336. https://doi.org/10.1097/GCO.0b013e328216f90b
Balasubramani L, Milliken DA, Shepherd JH, Ind TE (2011) Differences in hand movements and task completion times between laparoscopic, robotically assisted, and open surgery: an in vitro study. J Robot Surg 5:137–140. https://doi.org/10.1007/s11701-011-0248-9
Milone M, Manigrasso M, Anoldo P et al (2022) The role of robotic visceral surgery in patients with adhesions: a systematic review and meta-analysis. J Pers Med 12:307. https://doi.org/10.3390/jpm12020307
Nozaki T, Matsuda K, Kagami K, Sakamoto I (2023) Comparison of surgical outcomes between robot-assisted and conventional laparoscopic hysterectomy for large uterus. J Robot Surg 17:2415–2419. https://doi.org/10.1007/s11701-023-01673-0
Krielen P, Stommel MWJ, Pargmae P et al (2020) Adhesion-related readmissions after open and laparoscopic surgery: a retrospective cohort study (SCAR update). Lancet 395:33–41. https://doi.org/10.1016/S0140-6736(19)32636-4
Siufi Neto J, Santos Siufi DF, Magrina JF (2016) Trocar in conventional laparoscopic and robotic-assisted surgery as a major cause of iatrogenic trauma to the patient. Best Pract Res Clin Obstet Gynaecol 35:13–19. https://doi.org/10.1016/j.bpobgyn.2015.11.005
Ngu SF, Cheung VY, Pun TC (2011) Left upper quadrant approach in gynecologic laparoscopic surgery. Acta Obstet Gynecol Scand 90(12):1406–1409. https://doi.org/10.1111/j.1600-0412.2011.01257.x
van Goor H (2007) Consequences and complications of peritoneal adhesions. Colorectal Dis 9(Suppl 2):25–34. https://doi.org/10.1111/j.1463-1318.2007.01358.x
Park DA, Lee DH, Kim SW, Lee SH (2016) Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: a systematic review and meta-analysis. Eur J Surg Oncol 42:1303–1314. https://doi.org/10.1016/j.ejso.2016.06.400
Ind T, Laios A, Hacking M, Nobbenhuis M (2017) A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: a systematic review and meta-analysis. Int J Med Robot 13(4):e1851. https://doi.org/10.1002/rcs.1851
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Takahiro Nozaki, Kosuke Matsuda, and Ikuko Sakamoto contributed to the study conception and design. Material preparation was performed by all authors. Data collection was performed by Takahiro Nozaki and Kosuke Matsuda. Analysis was performed by Takahiro Nozaki. The first draft of the manuscript was written by Takahiro Nozaki and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This is an observational study. Approval was granted by the Yamanashi Central Hospital institutional review board (March 17, 2023 / 2022-51).
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Nozaki, T., Matsuda, K., Kagami, K. et al. Does the presence of abdominal wall adhesions make gynecologic robotic surgery difficult?. J Robotic Surg 18, 173 (2024). https://doi.org/10.1007/s11701-024-01938-2
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DOI: https://doi.org/10.1007/s11701-024-01938-2