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Role of Robotics in the Management of Infertility

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Textbook of Gynecologic Robotic Surgery

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Abstract

The relatively new field of robotic surgery is being used to manage a number of conditions related to female infertility.

Abdominal cerclage. Incompetent cervix is the inability of the uterine cervix to retain a pregnancy in the second trimester, in the absence of uterine contractions. Transvaginally or transabdominally performed cervical cerclages are the mainstay of surgical treatment. Transabdominal cerclage is generally reserved for when anatomy limits cerclage placement or transvaginal cervical cerclage procedures have previously failed. Open or minimally invasive options are available for transabdominal surgery, but robot-assisted cervical cerclage is rapidly gaining acceptance with its record of safety and procedure success.

Tubal reversal. Tubal ligation is widely accepted contraception method for women, in which pregnancy is prevented by disrupting fallopian tube patency. Although it is considered to be permanent, requests for reversal of the procedure (recanalization) are not infrequent. After robotic tubal reanastomosis, the overall pregnancy rate was found to be 71% at 2-year follow-up. Quicker recovery time and return to work, early hospital discharge, and smaller incisions are the main advantages of minimally invasive surgery over open surgery.

Reconstruction of uterine anomalies. Any disruption of Müllerian duct development during embryogenesis can result in Müllerian duct anomalies. Robotic technology has advantages over classical laparoscopy-related methods for surgical correction of Müllerian anomalies, especially in sigmoid vaginoplasty and robotic metroplasty. The use of a robot-assisted technique may enhance the safety of uterine transplantation surgeries in the future by facilitating the microvascular anastomosis, vaginal anastomosis, and ligaments fixation.

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References

  1. Moss C, Isley MM. Sterilization: a review and update. Obstet Gynecol Clin N Am. 2015;42(4):713–24.

    Article  Google Scholar 

  2. Hillis SD, Marchbanks PA, Tylor LR, et al. Poststerilization regret: findings from the United States collaborative review of sterilization. Obstet Gynecol. 1999;93(6):889–95.

    CAS  PubMed  Google Scholar 

  3. Henderson SR. The reversibility of female sterilization with the use of microsurgery: a report on 102 patients with more than one year of follow-up. Am J Obstet Gynecol. 1984;149(1):57–65.

    Article  CAS  PubMed  Google Scholar 

  4. Hanafi MM. Factors affecting the pregnancy rate after microsurgical reversal of tubal ligation. Fertil Steril. 2003;80(2):434–40.

    Article  PubMed  Google Scholar 

  5. Gordts S, Campo R, Puttemans P, et al. Clinical factors determining pregnancy outcome after microsurgical tubal reanastomosis. Fertil Steril. 2009;92(4):1198–202.

    Article  PubMed  Google Scholar 

  6. Yoon TK, Sung HR, Kang HG, et al. Laparoscopic tubal anastomosis: fertility outcome in 202 cases. Fertil Steril. 1999;72(6):1121–6.

    Article  CAS  PubMed  Google Scholar 

  7. Margossian H, Garcia-Ruiz A, Falcone T, et al. Robotically assisted laparoscopic tubal anastomosis in a porcine model: a pilot study. J Laparoendosc Adv Surg Tech A. 1998;8(2):69–73.

    Article  CAS  PubMed  Google Scholar 

  8. Degueldre M, Vandromme J, Huong PT, et al. Robotically assisted laparoscopic microsurgical tubal reanastomosis: a feasibility study. Fertil Steril. 2000;74(5):1020–3.

    Article  CAS  PubMed  Google Scholar 

  9. Falcone T, Goldberg JM, Margossian H, et al. Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study. Fertil Steril. 2000;73(5):1040–2.

    Article  CAS  PubMed  Google Scholar 

  10. Zite N, Borrero S. Female sterilisation in the United States. Eur J Contracept Reprod Health Care. 2011;16(5):336–40.

    Article  PubMed  Google Scholar 

  11. Gargiulo AR. Fertility preservation and the role of robotics. Clin Obstet Gynecol. 2011;54(3):431–48.

    Article  PubMed  Google Scholar 

  12. Bedaiwy MA, Barakat EM, Falcone T. Robotic tubal anastomosis: technical aspects. JSLS. 2011;15(1):10–15. PMC3134681.

    Google Scholar 

  13. Dharia Patel SP, Steinkampf MP, Whitten SJ, et al. Robotic tubal anastomosis: surgical technique and cost effectiveness. Fertil Steril. 2008;90(4):1175–9.

    Article  PubMed  Google Scholar 

  14. Einarsson JI, Hibner M, Advincula AP. Side docking: an alternative docking method for gynecologic robotic surgery. Rev Obstet Gynecol. 2011;4(3–4):123–5. PMC3252883.

    PubMed  PubMed Central  Google Scholar 

  15. Schippert C, Soergel P, Staboulidou I, et al. The risk of ectopic pregnancy following tubal reconstructive microsurgery and assisted reproductive technology procedures. Arch Gynecol Obstet. 2012;285(3):863–71.

    Article  PubMed  Google Scholar 

  16. Caillet M, Vandromme J, Rozenberg S, et al. Robotically assisted laparoscopic microsurgical tubal reanastomosis: a retrospective study. Fertil Steril. 2010;94(5):1844–7.

    Article  PubMed  Google Scholar 

  17. Rodgers AK, Goldberg JM, Hammel JP, et al. Tubal anastomosis by robotic compared with outpatient minilaparotomy. Obstet Gynecol. 2007;109(6):1375–80.

    Article  PubMed  Google Scholar 

  18. Lima M, Cantone N, Destro F, et al. Combined laparoscopic and hysteroscopic approach for the treatment of a hybrid Mullerian duct anomaly: a case report. J Laparoendosc Adv Surg Tech A. 2013;23(11):960–4.

    Article  PubMed  Google Scholar 

  19. Saygili-Yilmaz E, Yildiz S, Erman-Akar M, et al. Reproductive outcome of septate uterus after hysteroscopic metroplasty. Arch Gynecol Obstet. 2003;268(4):289–92.

    Article  PubMed  Google Scholar 

  20. Vallerie AM, Breech LL. Update in Mullerian anomalies: diagnosis, management, and outcomes. Curr Opin Obstet Gynecol. 2010;22(5):381–7.

    Article  PubMed  Google Scholar 

  21. Grimbizis GF, Gordts S, Di Spiezio Sardo A, et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013;28(8):2032–44. PMC3712660.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Arleo EK, Troiano RN. Complex Mullerian duct anomalies defying traditional classification: lessons learned. J Fertil. 2013;1:115.

    Google Scholar 

  23. Iverson R, Decherney A, Laufer M. Surgical management of congenital uterine anomalies. In: Barbieri R, editor. UpToDate. Waltham: Wolters Kluwer; 2016.

    Google Scholar 

  24. AFS. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49(6):944–55.

    Article  Google Scholar 

  25. Cunningham FG, Leveno KJ, Bloom SL, et al. Congenital genitourinary abnormalities. In:Williams obstetrics. New York: McGraw-Hill Education; 2014. p. 36–45.

    Google Scholar 

  26. Nahum GG. Uterine anomalies. How common are they, and what is their distribution among subtypes? J Reprod Med. 1998;43(10):877–87.

    CAS  PubMed  Google Scholar 

  27. Reichman D, Laufer MR, Robinson BK. Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril. 2009;91(5):1886–94.

    Article  PubMed  Google Scholar 

  28. Heinonen PK. Uterus didelphys: a report of 26 cases. Eur J Obstet Gynecol Reprod Biol. 1984;17(5):345–50.

    Article  CAS  PubMed  Google Scholar 

  29. Smith NA, Laufer MR. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome: management and follow-up. Fertil Steril. 2007;87(4):918–22.

    Article  PubMed  Google Scholar 

  30. Tong J, Zhu L, Lang J. Clinical characteristics of 70 patients with Herlyn-Werner-Wunderlich syndrome. Int J Gynaecol Obstet. 2013;121(2):173–5.

    Article  PubMed  Google Scholar 

  31. El Saman AM, Shahin AY, Nasr A, et al. Hybrid septate uterus, coexistence of bicornuate and septate varieties: a genuine report. J Obstet Gynaecol Res. 2012;38(11):1308–14.

    Article  PubMed  Google Scholar 

  32. Iverson R, Decherney A, Laufer M. Clinical manifestations and diagnosis of congenital anomalies of the uterus. In: Barbieri R, editor. UpToDate. Waltham: Wolters Kluwer; 2016.

    Google Scholar 

  33. Guirgis RR, Shrivastav P. Gamete intrafallopian transfer (GIFT) in women with bicornuate uteri. J In Vitro Fert Embryo Transf. 1990;7(5):283–4.

    Article  CAS  PubMed  Google Scholar 

  34. Marcus S, Al-Shawaf T, Brinsden P. The obstetric outcome of in vitro fertilization and embryo transfer in women with congenital uterine malformation. Am J Obstet Gynecol. 1996;175(1):85–9.

    Article  CAS  PubMed  Google Scholar 

  35. Markham SM, Waterhouse TB. Structural anomalies of the reproductive tract. Curr Opin Obstet Gynecol. 1992;4(6):867–73.

    Article  CAS  PubMed  Google Scholar 

  36. Pellerito JS, Mccarthy SM, Doyle MB, et al. Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology. 1992;183(3):795–800.

    Article  CAS  PubMed  Google Scholar 

  37. Acien P, Acien M, Sanchez-Ferrer M. Complex malformations of the female genital tract. New types and revision of classification. Hum Reprod. 2004;19(10):2377–84.

    Article  PubMed  Google Scholar 

  38. Chen YJ, Twu NF, Horng HC, et al. Robotic modified Jones metroplasty for uterine unification. J Minim Invasive Gynecol. 2010;17(6):S11–2.

    Article  Google Scholar 

  39. Gungor M, Afsar S, Ozbasli E, et al. The robotic metroplasty in a patient with hybrid septate variant anomaly. J Robot Surg. 2016;10(3):271–4.

    Article  PubMed  Google Scholar 

  40. Wright C, Hanna MK. Thirty-six vaginal constructions: lessons learned. J Pediatr Urol. 2014;10(4):667–71.

    Article  CAS  PubMed  Google Scholar 

  41. Committee on Adolescent Health Care. Committee opinion: no. 562: Mullerian agenesis: diagnosis, management, and treatment. Obstet Gynecol. 2013;121(5):1134–7.

    Article  Google Scholar 

  42. Dargent D, Marchiole P, Giannesi A, et al. Laparoscopic Davydov or laparoscopic transposition of the peritoneal colpopoeisis described by Davydov for the treatment of congenital vaginal agenesis: the technique and its evolution. Gynecol Obstet Fertil. 2004;32(12):1023–30.

    Article  CAS  PubMed  Google Scholar 

  43. Gauwerky JF, Wallwiener D, Bastert G. An endoscopically assisted technique for construction of a neovagina. Arch Gynecol Obstet. 1992;252(2):59–63.

    Article  CAS  PubMed  Google Scholar 

  44. Mcindoe A. The treatment of congenital absence and obliterative conditions of the vagina. Br J Plast Surg. 1950;2(4):254–67.

    CAS  PubMed  Google Scholar 

  45. Popp LW, Ghirardini G. Creation of a neovagina by pelviscopy. J Laparoendosc Surg. 1992;2(3):165–73.

    CAS  PubMed  Google Scholar 

  46. Urbanowicz W, Starzyk J, Sulislawski J. Laparoscopic vaginal reconstruction using a sigmoid colon segment: a preliminary report. J Urol. 2004;171(6 Pt 2):2632–5.

    Article  CAS  PubMed  Google Scholar 

  47. Kim C, Campbell B, Ferrer F. Robotic sigmoid vaginoplasty: a novel technique. Urology. 2008;72(4):847–9.

    Article  PubMed  Google Scholar 

  48. Boztosun A, Olgan S. Robotic sigmoid vaginoplasty in an adolescent girl with Mayer-Rokitansky-Kuster-Hauser syndrome. Female Pelvic Med Reconstr Surg. 2016;22(5):e32–5.

    Article  PubMed  Google Scholar 

  49. Pushkar P, Rawat SK, Chowdhary SK. Robotic approach to vaginal atresia repair in an adolescent girl. Urol Ann. 2015;7(3):396–8. PMC4518385.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Iavazzo C, Gkegkes ID. Possible role of DaVinci robot in uterine transplantation. J Turk Ger Gynecol Assoc. 2015;16(3):179–80. PMC4560477.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Braumann C, Jacobi CA, Menenakos C, et al. Computer-assisted laparoscopic colon resection with the Da Vinci system: our first experiences. Dis Colon Rectum. 2005;48(9):1820–7.

    Article  PubMed  Google Scholar 

  52. Denoto G, Rubach E, Ravikumar TS. A standardized technique for robotically performed sigmoid colectomy. J Laparoendosc Adv Surg Tech A. 2006;16(6):551–6.

    Article  PubMed  Google Scholar 

  53. Anderberg M, Bossmar T, Arnbjornsson E, et al. Robot-assisted laparoscopic hemihysterectomy for a rare genitourinary malformation with associated duplication of the inferior vena cava—a case report. Eur J Pediatr Surg. 2010;20(3):206–8.

    Article  CAS  PubMed  Google Scholar 

  54. Persson J, Reynisson P, Borgfeldt C, et al. Robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy with short and long term morbidity data. Gynecol Oncol. 2009;113(2):185–90.

    Article  PubMed  Google Scholar 

  55. Liu XX, Jiang ZW, Chen P, et al. Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes. World J Gastroenterol. 2013;19(38):6427–37. PMC3801313.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Uyama I, Sugioka A, Fujita J, et al. Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer. 1999;2(3):186–90.

    Article  PubMed  Google Scholar 

  57. Sheyn D, Abouassaly R, Paspulati R, et al. Multidisciplinary approach for management of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome and rectal prolapse. Int Urogynecol J. 2015;26(7):1079–81.

    Article  PubMed  Google Scholar 

  58. Cunningham FG, Leveno KJ, Bloom SL, et al. Abortion, early pregnancy. In:Williams obstetrics. New York: McGraw-Hill Education; 2014. p. 350–76.

    Google Scholar 

  59. Vyas NA, Vink JS, Ghidini A, et al. Risk factors for cervical insufficiency after term delivery. Am J Obstet Gynecol. 2006;195(3):787–91.

    Article  PubMed  Google Scholar 

  60. Saccone G, Perriera L, Berghella V. Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016;214(5):572–91.

    Article  PubMed  Google Scholar 

  61. Warren JE, Silver RM, Dalton J, et al. Collagen 1Alpha1 and transforming growth factor-beta polymorphisms in women with cervical insufficiency. Obstet Gynecol. 2007;110(3):619–24.

    Article  CAS  PubMed  Google Scholar 

  62. Chan YY, Jayaprakasan K, Tan A, et al. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol. 2011;38(4):371–82.

    Article  CAS  PubMed  Google Scholar 

  63. Rackow BW, Arici A. Reproductive performance of women with Mullerian anomalies. Curr Opin Obstet Gynecol. 2007;19(3):229–37.

    Article  PubMed  Google Scholar 

  64. Kaufman RH, Adam E, Hatch EE, et al. Continued follow-up of pregnancy outcomes in diethylstilbestrol-exposed offspring. Obstet Gynecol. 2000;96(4):483–9.

    CAS  PubMed  Google Scholar 

  65. Grobman WA, Gilbert SA, Iams JD, et al. Activity restriction among women with a short cervix. Obstet Gynecol. 2013;121(6):1181–6. PMC4019312.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Sciscione AC. Maternal activity restriction and the prevention of preterm birth. Am J Obstet Gynecol. 2010;202(3):232.e1–5.

    Article  Google Scholar 

  67. Abdel-Aleem H, Shaaban OM, Abdel-Aleem MA. Cervical pessary for preventing preterm birth. Cochrane Database Syst Rev. 2013;5:Cd007873.

    Google Scholar 

  68. Dharan VB, Ludmir J. Alternative treatment for a short cervix: the cervical pessary. Semin Perinatol. 2009;33(5):338–42.

    Article  PubMed  Google Scholar 

  69. Goya M, Pratcorona L, Merced C, et al. Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet (London, England). 2012;379(9828):1800–6.

    Article  Google Scholar 

  70. Herron MA, Parer JT. Transabdominal cerclage for fetal wastage due to cervical incompetence. Obstet Gynecol. 1988;71(6 Pt 1):865–8.

    CAS  PubMed  Google Scholar 

  71. Berghella V, Szychowski JM, Owen J, et al. Suture type and ultrasound-indicated cerclage efficacy. J Matern Fetal Neonatal Med. 2012;25(11):2287–90.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Harger JH. Comparison of success and morbidity in cervical cerclage procedures. Obstet Gynecol. 1980;56(5):543–8.

    CAS  PubMed  Google Scholar 

  73. Mcdonald IA. Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp. 1957;64(3):346–50.

    Article  CAS  PubMed  Google Scholar 

  74. Shirodkar V. A new method of operative treatment for habitual abortions in the second trimester of pregnancy. Antiseptic. 1955;52:299–300.

    Google Scholar 

  75. Toaff R, Toaff ME, Ballas S, et al. Cervical incompetence: diagnostic and therapeutic aspects. Isr J Med Sci. 1977;13(1):39–49.

    CAS  PubMed  Google Scholar 

  76. Burger NB, Brolmann HA, Einarsson JI, et al. Effectiveness of abdominal cerclage placed via laparotomy or laparoscopy: systematic review. J Minim Invasive Gynecol. 2011;18(6):696–704.

    Article  CAS  PubMed  Google Scholar 

  77. Wolfe L, Depasquale S, Adair CD, et al. Robotic-assisted laparoscopic placement of transabdominal cerclage during pregnancy. Am J Perinatol. 2008;25(10):653–5.

    Article  PubMed  Google Scholar 

  78. Fick AL, Caughey AB, Parer JT. Transabdominal cerclage: can we predict who fails? J Matern Fetal Neonatal Med. 2007;20(1):63–7.

    Article  PubMed  Google Scholar 

  79. Umstad MP, Quinn MA, Ades A. Transabdominal cervical cerclage. Aust N Z J Obstet Gynaecol. 2010;50(5):460–4.

    Article  PubMed  Google Scholar 

  80. Davis G, Berghella V, Talucci M, et al. Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage. Am J Obstet Gynecol. 2000;183(4):836–9.

    Article  CAS  PubMed  Google Scholar 

  81. Tulandi T, Alghanaim N, Hakeem G, et al. Pre and post-conceptional abdominal cerclage by laparoscopy or laparotomy. J Minim Invasive Gynecol. 2014;21(6):987–93.

    Article  PubMed  Google Scholar 

  82. Zeybek B, Hill A, Menderes G, et al. Robot-assisted abdominal cerclage during pregnancy. JSLS. 2016;20(4):e2016.00072. PMC5118107.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Estape RE, Schroeder ED, Estape RA, et al. Robotic abdominal cerclage: a case series with pregnancy outcomes. J Minim Invasive Gynecol. 2015;22(6s):S235.

    Article  CAS  PubMed  Google Scholar 

  84. ACOG. ACOG Practice Bulletin No.142: cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014;123(2 Pt 1):372–9.

    Google Scholar 

  85. Walsh TM, Borahay MA, Fox KA, et al. Robotic-assisted, ultrasound-guided abdominal cerclage during pregnancy: overcoming minimally invasive surgery limitations? J Minim Invasive Gynecol. 2013;20(3):398–400.

    Article  PubMed  Google Scholar 

  86. Zeybek B, Borahay M, Kilic GS. Overcoming the obstacles of visualization in robotically assisted abdominal cerclage using indocyanine green. J Robot Surg. 2016;10(4):361–4.

    Article  PubMed  Google Scholar 

  87. Dawood F, Farquharson RG. Transabdominal cerclage: preconceptual versus first trimester insertion. Eur J Obstet Gynecol Reprod Biol. 2016;199:27–31.

    Article  PubMed  Google Scholar 

  88. Pundir J, Coomarasamy A. Preterm labour (PTL). In:Obstetrics: evidence-based algorithms. London: Cambridge University Press; 2016.

    Chapter  Google Scholar 

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Authors and Affiliations

  1. Division of Minimally Invasive Gynecology and Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA

    Sami Gokhan Kilic M.D., F.A.C.O.G., F.A.C.S., Bekir Serdar Unlu M.D. & Mertihan Kurdoglu M.D.

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  1. Sami Gokhan Kilic M.D., F.A.C.O.G., F.A.C.S.
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  2. Bekir Serdar Unlu M.D.
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Correspondence to Sami Gokhan Kilic M.D., F.A.C.O.G., F.A.C.S. .

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Editors and Affiliations

  1. Department of Gynaecological Oncology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, West Midlands, United Kingdom

    Alaa El-Ghobashy

  2. Department of Gynaecological Oncology, Royal Marsden and St George’s Hospitals, London, United Kingdom

    Thomas Ind

  3. Department of Obstetrics and Gynecology, Skane University Hospital, Lund, Sweden

    Jan Persson

  4. Department of Gynecological Oncology, Mayo Clinic, Phoenix, Arizona, USA

    Javier F. Magrina

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Kilic, S.G., Unlu, B.S., Kurdoglu, M. (2018). Role of Robotics in the Management of Infertility. In: El-Ghobashy, A., Ind, T., Persson, J., Magrina, J. (eds) Textbook of Gynecologic Robotic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-63429-6_9

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