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Current Obstetrics and Gynecology Reports

, Volume 4, Issue 3, pp 152–158 | Cite as

Minimally Invasive Surgery in Gynecology: Underutilized?

  • Amanda RamosEmail author
  • Amanda N. Fader
Minimally Invasive Gynecologic Surgery (A Fader, Section Editor)
  • 91 Downloads
Part of the following topical collections:
  1. Topical Collection on Minimally Invasive Gynecologic Surgery

Abstract

Minimally invasive gynecologic surgery encompasses vaginal, laparoscopic, and robotic-assisted surgery. In this review, we highlight the current use of laparoscopic and robotic-assisted surgery in benign and oncologic gynecology and explore whether utilization is optimal. Given the many benefits associated with minimally invasive surgery, including fewer perioperative complications, less blood loss, and faster recovery times, it is critical to offer as many gynecologic surgery patients as possible a minimally invasive approach.

Keywords

Laparoscopic gynecologic surgery Robotic gynecologic surgery Laparoendoscopic single-site surgery Minimally invasive gynecologic surgery Utilization of minimally invasive surgery 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Amanda Ramos and Amanda N. Fader declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Spaner SJ et al. A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J Laparoendosc Adv Surg Tech. 1997;7(6):369–73.CrossRefGoogle Scholar
  2. 2.
    Bijen CB, Vermeulen KM, Mourits MJ, de Bock GH. Costs and effects of abdominal versus laparoscopic hysterectomy: systematic review of controlled trials. PLoS ONE. 2009;4, e7340.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Klaiber C, Metzger A, Petelin JB. Manual of laparoscopic surgery. Seattle: Hagrefe and Huber; 1993.Google Scholar
  4. 4.
    Gomella LG, Kozminski M, Wingield HN. Laparoscopic urologie surgery. New York: Raven; 1994.Google Scholar
  5. 5.
    Gaskin TA, Ische JH, Matthews JL, Wincester SB, Smith RJ: Laparoscopy and the general surgeon. Surg Clin North Am. 1991;71(5):1085–97.Google Scholar
  6. 6.•
    Cooper MA, Hutfless S, Segev DL, Ibrahim A, Lyu H, Makary MA. Hospital level under-utilization of minimally invasive surgery in the United States: retrospective review. BMJ. 2014;349:g4198. doi: 10.1136/bmj.g4198. This is an article published in July of 2014 focusing on the utilization of several minimally invasive procedures including hysterectomy throughout the USA. This article highlights the factors influencing the use of minimally invasive gynecologic surgery including regions of the USA, size of hospital, and case volume as factors that influence the use of minimally invasive hysterectomy. PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Tanner SA, Scheib EJ, Fader AN. Laparoscopy in the morbidly obese: physiologic considerations and surgical techniques to optimize success. J Minim Invasive Gynecol. 2014;21(2):182–95.PubMedCrossRefGoogle Scholar
  8. 8.
    Intuitive Surgical. Investor information. Available from: http://phx.corporate-ir.net/phoenix.zhtml?c=122359&p=irol-IRHome. Last accessed 15 Sept 2014
  9. 9.
    Mabrouk M, Frumovitz M, Greer M, Sharma S, Schmeler KM, Soliman PT. Trends in laparoscopic and robotic surgery among gynecologic oncologists: a survey update. Gynecol Oncol. 2009;112:501–5.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Sfakianos GP, Frederick PJ, Kendrick JE, Straughn JM, Kilgore LC, Huh WK. Robotic surgery in gynecologic oncology fellowship programs in the USA: a survey of fellows and fellowship directors. Int J Med Rob. 2010;6:405–12.CrossRefGoogle Scholar
  11. 11.
    Sinno AK, Fader AN. Robotic-assisted surgery in gynecologic oncology. Fertil Steril. 2014;102(4):922–32. doi: 10.1016/j.fertnstert.2014.08.020. Review.PubMedCrossRefGoogle Scholar
  12. 12.•
    Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;(3):CD00367. This Cochrane review published in 2009 is an analysis of the use of minimally invasive hysterectomy. This analysis included 34 studies with 4495 women and highlights the benefits of minimally invasive surgery compared to abdominal hysterectomy.Google Scholar
  13. 13.
    Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstet Gynecol. 2002;99(2):229–34.PubMedCrossRefGoogle Scholar
  14. 14.
    Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110(5):1091–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Jacoby VL, Autry A, Jacobson G, Domush R, Nakagawa S, Jacoby A. Nationwide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches. Obstet Gynecol. 2009;114(5):1041–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen SL et al. Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy. JSLS. 2014;18(3):e2014.00096.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Wright JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu YS, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122(2 Pt 1):233–41.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.•
    Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 study. J Clin Oncol. 2012;30:695–700. This article published in 2012 focuses on laparoscopy compared to laparotomy in the staging of endometrial cancer. This publication highlights that laparoscopic surgical management of uterine cancer is superior for short-term safety and length-of-stay outcomes in patient. The potential for increased risk of cancer recurrence with laparoscopy versus laparotomy was quantified in this study and it was found to be minimal, aiding in decision-making for women with uterine cancer. PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group study LAP2. J Clin Oncol. 2009;27:5331–533.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Abu-Rustum NR, Gemignani ML, Moore K, et al. Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy. Gynecol Oncol. 2003;91:402–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Altgassen C, Possover M, Krause N, Plaul K, Michels W, Schneider A. Establishing a new technique of laparoscopic pelvic and para-aortic lymphadenectomy. Obstet Gynecol. 2000;95:348–52.PubMedCrossRefGoogle Scholar
  22. 22.
    Childers JM, Hatch KD, Tran AN, Surwit EA. Laparoscopic para-aortic lymphadenectomy in gynecologic malignancies. Obstet Gynecol. 1993;82:741–7.PubMedGoogle Scholar
  23. 23.
    Chu CS, Randall TC, Bandera CA, Rubin SC. Vaginal cuff recurrence of endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy. Gynecol Oncol. 2003;88:62–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Kohler C, Klemm P, Schau A, et al. Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies. Gynecol Oncol. 2004;95:52–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Tozzi R, Malur S, Koehler C, Schneider A. Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study. J Minim Invasive Gynecol. 2005;12:130–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Boggess JF, Gehrig PA, Cantrell L, et al. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008;199:360.e1–9.CrossRefGoogle Scholar
  27. 27.
    Ran L, Jin J, Xu Y, Bu Y, Song F. Comparison of robotic surgery with laparoscopy and laparotomy for treatment of endometrial cancer: a meta-analysis. PLoS ONE. 2014;26:9(9).Google Scholar
  28. 28.
    Paley PJ, Veljovich DS, Shah CA, Everett EN, Bondurant AE, Drescher CW, et al. Surgical outcomes in gynecologic oncology in the era of robotics: analysis of first 1000 cases. Am J Obstet Gynecol. 2011;204:551.e1–9.CrossRefGoogle Scholar
  29. 29.
    Holloway RW, Ahmad S, DeNardis SA, Peterson LB, Sultana N, Bigsby 4th GE, et al. Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: analysis of surgical performance. Gynecol Oncol. 2009;115:447–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Hoekstra AV, Morgan JM, Lurain JR, Buttin BM, Singh DK, Schink JC, et al. Robotic surgery in gynecologic oncology: impact on fellowship training. Gynecol Oncol. 2009;114:168–17.PubMedCrossRefGoogle Scholar
  31. 31.
    Ju W, Myung SK, Kim Y, Choi HJ, Kim SC. Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a meta-analysis. Int J Gynecol Cancer. 2009;19:400–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Gómez-Hidalgo NR et al. Predictors of optimal cytoreduction in patients with newly diagnosed advanced-stage epithelial ovarian cancer: time to incorporate laparoscopic assessment into the standard of care. Gynecol Oncol. 2015. doi: 10.1016/j.ygyno.2015.03.049.PubMedGoogle Scholar
  33. 33.
    RuttenMJ, LeeflangMMG, Kenter GG, Mol BWJ, Buist M. Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer. Cochrane Database Syst Rev 2014;(Issue 2).Google Scholar
  34. 34.
    Sisodia RM, Del Carmen MG, Boruta DM. Role of minimally invasive surgery in the management of adnexal masses. Clin Obstet Gynecol. 2015;58(1):66–75. doi: 10.1002/14651858.CD009786.PubMedCrossRefGoogle Scholar
  35. 35.
    ACOG Committee Opinion No. 444: choosing the route o hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156–1158Google Scholar
  36. 36.
    Sarlos D, Kots L, Stevanovic N, von Felten S, Schar G. Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol. 2012;120:604–11.PubMedCrossRefGoogle Scholar
  37. 37.
    Paraiso MF, Jelovsek JE, Frick A, Chen CC, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118:1005–13.PubMedCrossRefGoogle Scholar
  38. 38.
    Paraiso MF, Ridgeway B, Park AJ, Jelovsek JE, Barber MD, Falcone T, et al. A randomized trial comparing conventional and robotically assisted total laparoscopic hysterectomy. Am J Obstet Gynecol. 2013;208:368.e1–7.CrossRefGoogle Scholar
  39. 39.
    Visco AG, Advincula AP. Robotic gynecologic surgery. Obstet Gynecol. 2008;112:1369–84.PubMedCrossRefGoogle Scholar
  40. 40.
    Anger JT, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman A, et al. Robotic compared with laparoscopic sacrocolpopexy; a randomized controlled trial. Obstet Gynecol. 2014;123:5–12.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol. 2011;18(1):1–3.Google Scholar
  42. 42.•
    Gala RB, Margulies R, Steinberg A, Murphy M, Lukban J, Jeppson P, et al. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol. 2014;21(3):353–61. This article published in May of 2014 focuses on the use of robotic hysterectomy techniques compared to laparoscopy and abdominal surgery. PubMedCrossRefGoogle Scholar
  43. 43.
    Díaz-Feijoo B, Gil-Ibáñez B, Pérez-Benavente A, Martínez-Gómez X, Colás E, Sánchez-Iglesias JL, et al. Comparison of robotic-assisted vs conventional laparoscopy for extraperitoneal paraaortic lymphadenectomy. Gynecol Oncol. 2014;132(1):98–101.PubMedCrossRefGoogle Scholar
  44. 44.
    Corrado G, Fanfani F, Ghezzi F, Fagotti A, Uccella S, Mancini E, et al. Mini-laparoscopic versus robotic radical hysterectomy plus systematic pelvic lymphadenectomy in early cervical cancer patients. A multi-institutional study. Eur J Surg Oncol. 2015;41(1):136–41.PubMedCrossRefGoogle Scholar
  45. 45.
    Gaia G, Holloway RW, Santoro L, Ahmad S, di Silverio E, Spinillo A. Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review. Obstet Gynecol. 2010;116:1422–31.PubMedCrossRefGoogle Scholar
  46. 46.
    Fanfani F, Fagotti A, Rossitto C, et al. Laparoscopic, minilaparoscopic and single-port hysterectomy: perioperative outcomes. Surg Endosc. 2012;26:3592–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Fagotti A, Boruta DM, Scambia G, et al. First 100 early endometrial cancer cases treated with laparoendoscopic single-site surgery: a multicentric retrospective study. Am J Obstet Gynecol. 2012;206:353.e1–6.CrossRefGoogle Scholar
  48. 48.
    Boruta DM, Fagotti A, Bradford LS, Escobar PF, Scambia G, Kushnir CL, et al. Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy: initial multi-institutional experience for treatment of invasive cervical cancer. J Minim Invasive Gynecol. 2014;21(3):394–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Fanfani F, Boruta DM, Fader AN, Vizza E, Growdon WB, Kushnir CL, et al. Feasibility and surgical outcome in obese versus nonobese patients undergoing laparoendoscopic single-site hysterectomy: a multicenter case–control study. J Minim Invasive Gynecol. 2015;22(3):456–61.PubMedCrossRefGoogle Scholar
  50. 50.
    Fader AN, Levinson KL, Gunderson CC, Winder AD, Escobar PF. Laparoendoscopic single-site surgery in gynaecology: a new frontier in minimally invasive surgery. J Minim Access Surg. 2011;7(1):71–7.PubMedCentralPubMedGoogle Scholar
  51. 51.
    Scheib SA, Fader AN. Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique. Am J Obstet Gynecol. 2015;212(2):179.e1–8. doi: 10.1016/j.ajog.2014.07.057.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Kelly Gynecologic Oncology Service, Department of Gynecology and ObstetricsJohns Hopkins HospitalBaltimoreUSA

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