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Robotic Surgery for Gynaecologic Cancer: An Overview

  • Gynecologic Cancers (NS Reed, Section Editor)
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Abstract

After decades of reluctance to change surgical approaches, new technologies have created new perspectives for surgery. Initially, the laparoscopic approach was considered to be only one useful for relatively simple procedures as the design of the instruments and the limited access hampered free movements to perform complicated surgery. Robotic systems overcame this problem and boosted the use of minimally invasive techniques also for radical gynaecological surgery. Robot-assisted laparoscopy can now routinely be used for the surgical treatment of early or downstaged cervical carcinoma, endometrial carcinoma and staging of early ovarian carcinoma. Robot-assisted laparoscopy has proven to be feasible, although the benefits for the patient are less clear than those for the surgeon. The main advantage of robot-assisted laparoscopy over conventional laparoscopy is probably not that it is safer or better, but that it allows more types of radical surgery to be performed and that it prevents the surgeon from developing complaints and muscular conditions that interfere with the ability to perform surgery. New applications have emerged with the introduction of new devices to be used in conjunction with the robotic system as well as with totally new robotic systems. Training in these new tools should be more systematic and structured to allow their safe introduction and use.

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References

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

  1. Wertheim E. The extended abdominal operation for carcinoma uteri. Am J Obstet Dis Women Child. 1912;66:169–232.

    Google Scholar 

  2. Reich H, DeCaprio J, et al. Laparoscopic hysterectomy. J Gynecol Surg. 1989;5:213–6.

    Article  Google Scholar 

  3. Dargent D. A new future for Schauta’s operation through pre-surgical retroperitoneal pelviscopy. Eur J Gynaecol Oncol. 1987;8:292–6.

    Google Scholar 

  4. Nezhat CR, Burrell MO, Nezhat FR, et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol. 1992;166:864–5.

    PubMed  CAS  Google Scholar 

  5. Sert BM, Abeler VM. Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection–case report. Eur J Gynaecol Oncol. 2006;27:531–3.

    PubMed  CAS  Google Scholar 

  6. Wexner SD, Bergamaschi R, Lacy A, et al. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc. 2009;23:438–43.

    Article  PubMed  Google Scholar 

  7. Sarlos D, Kots LV, Stevanovic N, et al. Robotic hysterectomy versus conventional laparoscopic hysterectomy: costs and preliminary results of a randomized controlled trial. Arch Gynecol Obstet. 2010;282(Suppl):11–2.

    Google Scholar 

  8. Paraiso MF, Jelovsek JE, Frick A, et al. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118:1005–13.

    Article  PubMed  Google Scholar 

  9. Baik SH, Ko YT, Kang CM, et al. Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc. 2008;22:1601–8.

    Article  PubMed  CAS  Google Scholar 

  10. Liu H, Lu D, Wang L, Shi G, Song H, Clarke J. Robotic surgery for benign gynaecological disease. Cochrane Database Syst Rev. 2012, Issue 2. Art. No.: CD008978. doi:10.1002/14651858.CD008978.pub2.

  11. Lu D, Liu Z, Shi G, Liu D, Zhou X. Robotic assisted surgery for gynaecological cancer. Cochrane Database Syst Rev. 2012, Issue 1. Art. No.: CD008640. doi:10.1002/14651858.CD008640.pub2.

  12. Obermair A, Gebski V, Frumovitz M, Soliman PT, Schmeler KM, Levenback C, et al. A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. J Minim Invasive Gynecol. 2008;15:584–8.

    Article  PubMed  Google Scholar 

  13. • Herron DM, Marohm M. The SAGES MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery. Surg Endosc. 2008;22:313–25. This article is an example of recommendations and rules for the safe introduction of robotic surgery.

    Article  PubMed  CAS  Google Scholar 

  14. Inspectie voor de Gezondheidszorg. Ministerie van Volksgezondheid, Welzijn en Sport. Onvoldoende zorgvuldigheid bij introductie van operatierobots. Den Haag: 2010.

  15. Seamon LG, Fowler JM, Richardson DL, et al. A detailed analysis of the learning curve: robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Gynecol Oncol. 2009;114:162–7.

    Article  PubMed  Google Scholar 

  16. •• Schreuder HW, Wolswijk R, Zweemer RP, et al. Training and learning robotic surgery, time for a more structured approach: a systematic review. BJOG. 2012;119:137–49. This article highlights the importance of training in robot-assisted laparoscopy and gives an overview of requirements and current possibilities for adequate training.

    Article  PubMed  CAS  Google Scholar 

  17. Boggess JF, Gehrig PA, Cantrell L, et al. A case–control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol. 2008;199:357.e1–7.

    Article  Google Scholar 

  18. Kruijdenberg CB, van den Einden LC, Hendriks JC, et al. Robot-assisted versus total laparoscopic radical hysterectomy in early cervical cancer, a review. Gynecol Oncol. 2011;120:334–9.

    Article  PubMed  CAS  Google Scholar 

  19. Persson J, Kannisto P, Bossmar T. Robot-assisted abdominal laparoscopic radical trachelectomy. Gynecol Oncol. 2008;111:564–7.

    Article  PubMed  CAS  Google Scholar 

  20. Burnett AF, Stone PJ, Duckworth LA, et al. Robotic radical trachelectomy for preservation of fertility in early cervical cancer: case series and description of technique. J Minim Invasive Gynecol. 2009;16:569–72.

    Article  PubMed  CAS  Google Scholar 

  21. Lambaudie E, Narducci F, Bannier M, et al. Role of robot-assisted laparoscopy in adjuvant surgery for locally advanced cervical cancer. Eur J Surg Oncol. 2010;36:409–13.

    Article  PubMed  CAS  Google Scholar 

  22. Chan WS, Kong KK, Nikam YA, et al. Vaginal vault dehiscence after laparoscopic hysterectomy over a nine-year period at Sydney West Advanced Pelvic Surgery Unit - our experiences and current understanding of vaginal vault dehiscence. Aust N Z J Obstet Gynaecol. 2012;52:121–7.

    Article  PubMed  Google Scholar 

  23. 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;113:185–90.

    Article  PubMed  Google Scholar 

  24. Uccella S, Ghezzi F, Mariani A, et al. Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature. Am J Obstet Gynecol. 2011;205:119.e1–12.

    Article  Google Scholar 

  25. Hwang JH, Lee JK, Lee NW, et al. Vaginal cuff closure: a comparison between the vaginal route and laparoscopic suture in patients undergoing total laparoscopic hysterectomy. Gynecol Obstet Invest. 2011;71:163–9.

    Article  PubMed  Google Scholar 

  26. ElSahwi KS, Hooper C, De Leon MC, et al. Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer. Gynecol Oncol. 2012;124:260–4.

    Article  PubMed  Google Scholar 

  27. Mourits MJ, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol. 2010;11:763–71.

    Article  PubMed  Google Scholar 

  28. Obermair A, Janda M, Baker J, Kondalsamy-Chennakesavan S, et al. Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: results from a randomised controlled trial. Eur J Cancer. 2012;48:1147–53.

    Article  PubMed  Google Scholar 

  29. Barnett JC, Judd JP, Wu JM, et al. Cost comparison among robotic, laparoscopic, and open hysterectomy for endometrial cancer. Obstet Gynecol. 2010;116:685–93.

    Article  PubMed  Google Scholar 

  30. Holloway RW, Brudie LA, Rakowski JA, et al. Robotic-assisted resection of liver and diaphragm recurrent ovarian carcinoma: description of technique. Gynecol Oncol. 2011;120:419–22.

    Article  PubMed  Google Scholar 

  31. Magrina JF, Zanagnolo V, Noble BN, et al. Robotic approach for ovarian cancer: perioperative and survival results and comparison with laparoscopy and laparotomy. Gynecol Oncol. 2011;121:100–5.

    Article  PubMed  Google Scholar 

  32. Farghaly SA. Robotic-assisted laparoscopic anterior pelvic exenteration in patients with advanced ovarian cancer: Farghaly's technique. Eur J Gynaecol Oncol. 2010;31(4):361–3.

    PubMed  CAS  Google Scholar 

  33. Reynolds RK, Burke WM, Advincula AP. Preliminary experience with robot-assisted laparoscopic staging of gynecologic malignancies. JSLS. 2005;9:149–58.

    PubMed  Google Scholar 

  34. Ordemann J, Jacobi CA, Schwenk W, et al. Cellular and humoral inflammatory response after laparoscopic and conventional colorectal resections. Surg Endosc. 2001;15:600–8.

    Article  PubMed  CAS  Google Scholar 

  35. Zhang N, Liu H, Zhang Z, et al. The difference of the impacts of surgical approaches on cellular immunity in patients with uterine malignancies: a comparative study of laparoscopy and laparotomy surgery. Gynecol Obstet Invest. 2011;71:177–82.

    Article  PubMed  Google Scholar 

  36. Sylla P, Kirman I, Whelan RL. Immunological advantages of advanced laparoscopy. Surg Clin North Am. 2005;85(1):1–18. vii.

    Article  PubMed  Google Scholar 

  37. Sert B. Robotic port-site and pelvic recurrences after robot-assisted laparoscopic radical hysterectomy for a stage IB1 adenocarcinoma of the cervix with negative lymph nodes. Int J Med Robot. 2010;6:132–5.

    PubMed  Google Scholar 

  38. van de Lande J, von Mensdorff-Pouilly S, Lettinga RG, et al. Open versus laparoscopic pelvic lymph node dissection in early stage cervical cancer: no difference in surgical or disease outcome. Int J Gynecol Cancer. 2012;22:107–14.

    Article  PubMed  Google Scholar 

  39. Schreuder HW, Verheijen RH. Robotic surgery. BJOG. 2009;116:198–213.

    Article  PubMed  CAS  Google Scholar 

  40. Zorn KC, Gautam G, Shalhav AL. Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the Society of Urologic Robotic Surgeons. J Urol. 2009;182:1126–32.

    Article  PubMed  Google Scholar 

  41. van Dam GM, Themelis G, Crane LM, et al. Intraoperative tumor-specific fluorescence imaging in ovarian cancer by folate receptor-alpha targeting: first in-human results. Nat Med. 2011;17:1315–9.

    Article  PubMed  Google Scholar 

  42. Crane LM, Themelis G, Pleijhuis RG, et al. Intraoperative multispectral fluorescence imaging for the detection of the sentinel lymph node in cervical cancer: a novel concept. Mol Imaging Biol. 2011;13(5):1043–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Women & Baby, Gynaecological Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    René Verheijen & Ronald Zweemer

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  1. René Verheijen
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  2. Ronald Zweemer
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Correspondence to René Verheijen.

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Verheijen, R., Zweemer, R. Robotic Surgery for Gynaecologic Cancer: An Overview. Curr Oncol Rep 14, 544–549 (2012). https://doi.org/10.1007/s11912-012-0270-8

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  • DOI: https://doi.org/10.1007/s11912-012-0270-8

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