Minimally Invasive Surgery in Gynecology: Underutilized?
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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.
KeywordsLaparoscopic gynecologic surgery Robotic gynecologic surgery Laparoendoscopic single-site surgery Minimally invasive gynecologic surgery Utilization of minimally invasive surgery
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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.
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- 3.Klaiber C, Metzger A, Petelin JB. Manual of laparoscopic surgery. Seattle: Hagrefe and Huber; 1993.Google Scholar
- 4.Gomella LG, Kozminski M, Wingield HN. Laparoscopic urologie surgery. New York: Raven; 1994.Google Scholar
- 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.•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
- 8.Intuitive Surgical. Investor information. Available from: http://phx.corporate-ir.net/phoenix.zhtml?c=122359&p=irol-IRHome. Last accessed 15 Sept 2014
- 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
- 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
- 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
- 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
- 35.ACOG Committee Opinion No. 444: choosing the route o hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156–1158Google Scholar
- 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.•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
- 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