“Robot-assisted Laparoscopic Myomectomy Is an Improvement Over Laparotomy in Women with a Limited Number of Myomas.”
Ascher-Walsh, C. J. and T. L. Capes (2010).
Journal of Minimally Invasive Gynecology.
STUDY OBJECTIVE: To compare surgical and immediate postoperative results of robot-assisted laparoscopic myomectomy vs myomectomy via laparotomy in patients with 3 myomas or fewer. DESIGN: Case-control (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Seventy-five women who had undergone robotic-assisted laparoscopic myomectomy were compared with patients who had undergone myomectomy via laparotomy. INTERVENTIONS: Medical records were reviewed for surgical and postoperative variables. Both groups had 3 myomas or fewer confirmed at preoperative magnetic resonance imaging or final pathology report. MEASUREMENTS AND MAIN RESULTS: No significant differences were observed between patients insofar as preoperative demographic data. There was a significant increase in mean duration of surgery for robotic-assisted myomectomy. There was a significant decrease in blood loss, change in hematocrit concentration on postoperative day 1, length of stay, number of days to regular diet, and febrile morbidity in robotic-assisted myomectomies. There were no significant differences in operative or postoperative complications. CONCLUSION: Although robotic-assisted myomectomy took substantially longer, most of the other variables improved in comparison with similar procedures performed via laparotomy.
“Impact of robotic surgery on obstetric-gynecologic resident training.”
Brenot, K. and G. L. Goyert (2009).
The Journal of reproductive medicine 54(11-12): 675-677.
OBJECTIVE: To compare the volume and type of surgical techniques for hysterectomies performed prior to and after the introduction of robotic surgery at our institution and to assess the potential impact on obstetric-gynecologic resident training. STUDY DESIGN: A retrospective study examined the number and types of hysterectomies performed at our institution during the 18 months prior to, and the 18 months after, the introduction of a robotic surgical system. Procedures performed during both time periods were compared by number and percentage using the chi2 or Fisher’s exact test for counts < 5. RESULTS: A total of 903 hysterectomies were performed from July 1, 2005, to July 1, 2008. There were 444 hysterectomies in the prerobotic surgical system group and 459 hysterectomies in the postrobotic surgical system group. There was a statistically significant decrease in the number of laparoscopically assisted vaginal hysterectomies (94 vs. 36; p < 0.001) and total abdominal hysterectomies (249 vs. 203; p < 0.001) performed. CONCLUSION: This study demonstrated a significant impact on the volume and type of surgical techniques for hysterectomies performed prior to and after the introduction of robotic surgery at our institution. This observation may have direct consequences for obstetric-gynecologic resident surgical experience.
“Applications of Robotic Surgery in Gynecology.”
Matthews, C. A. (2010).
J Womens Health (Larchmt).
Abstract This article reviews the applications of robotic surgery in gynecology and presents a summary of the early studies that have been performed regarding its use for hysterectomy, myomectomy, reproductive surgery, pelvic floor reconstruction, and gynecological cancer staging. Despite significant advances in conventional laparoscopic techniques, the majority of gynecological procedures are still performed through major abdominal incisions, which are associated with higher surgical morbidity. This article addresses the potential that robotic surgery may have in converting more gynecological operations to a minimally invasive approach.
“Recovery after robot-assisted laparoscopic sacrocolpopexy: the patients’ perspective.”
McNanley, A. R., E. E. Duecy, et al. (2010).
Journal of Robotic Surgery: 1-5.
Little information exists about recovery after robot-assisted laparoscopic sacrocolpopexy. We sought to report on subjects’ perioperative experience. Subjects were queried about resumption of activities such as work and driving, bowel function, whether recovery went as expected, and whether they would recommend this surgery. Use of pain medications, pain scores, and perioperative data were collected N = 21. All would recommend surgery to a friend. 13/18 (72%) felt their recovery went better than expected, and none responded it was worse than expected. 9/21 (43%) did not use narcotics after the day of surgery, with 15/21 (71%) no longer taking narcotics by postoperative day 4. Fifty-five percent experienced their first postoperative bowel movement as painful. Based on this survey, most patients undergoing robot-assisted laparoscopic sacrocolpopexy will not require narcotics beyond postoperative day 3. Nonsteroidals are the mainstay of pain management. This survey highlights the importance of preventing postoperative constipation/ painful defecation. © 2010 Springer-Verlag London Ltd.