“Robotic surgery in gynecologic oncology.”
Bandera, C. A. and J. F. Magrina (2009).
Curr Opin Obstet Gynecol 21(1): 25-30.
PURPOSE OF REVIEW: Robotic surgery is rapidly taking the place of laparoscopy in many gynecologic oncology practices. Numerous practitioners have published their experience with this new technology. A review of their findings is timely and relevant. RECENT FINDINGS: The majority of case series of robotic surgery for hysterectomy and lymphadenectomy show that the procedure is feasible and at least comparable to laparoscopic surgery. Similarly, case series of robotic radical hysterectomy for cervical cancer also compare favorably to laparoscopic surgery. Less common procedures such as robotic trachelectomy, parametrectomy, and retroperitoneal lymphadenectomy have also been described. Numerous patient and practitioner advantages are discussed in this review. SUMMARY: Robotic surgery is a minimally invasive alternative to laparoscopy for the surgical treatment of endometrial cancer and cervical cancer. Its role in ovarian cancer is just starting to be explored.
“Robotic radical hysterectomy.”
Fanning, J., R. Hojat, et al. (2009).
Minerva Ginecol 61(1): 53-5.
Robotic radical hysterectomy is increasingly being utilized in the treatment of cervical cancer and initial studies are promising. Compared to open radical hysterectomy, robotic radical hysterectomy is expected to result in decreased pain, infection, length of stay, and adhesions and quicker return to activity. Prospective randomized controlled trials are needed to compare robotic, laparoscopic and open radical hysterectomy for the treatment of cervical cancer.
“Trends in laparoscopic and robotic surgery among gynecologic oncologists: A survey update.”
Mabrouk, M., M. Frumovitz, et al. (2009).
Gynecol Oncol 112(3): 501-5.
OBJECTIVES: To assess the use of traditional and robotic assisted laparoscopy by Society of Gynecologic Oncology (SGO) members and to compare the results with those of our published survey in 2004. METHODS: Surveys were mailed to SGO members, and anonymous responses were collected by mail or through a web site. Data were analyzed and compared with those of our previous survey. In addition, we gathered information on the effect of robotic assisted surgery on the management of gynecologic malignancies. RESULTS: Three hundred eighty-eight (46%) of 850 SGO members responded to the survey. Three hundred fifty-two (91%) indicated that they performed laparoscopic surgery in their practice (compared with 84% in the 2004 survey). The three most common laparoscopic procedures were laparoscopic hysterectomy and staging for uterine cancer (43%), diagnostic laparoscopy for adnexal masses (39%), and prophylactic bilateral oophorectomy for high-risk women (11%). Although 76% of respondents had received either limited or no laparoscopic training during their fellowship, 78% now believe that maximum or much emphasis should be placed on laparoscopic training (55% in the 2004 survey). Twenty-four percent of respondents indicated that they performed robotic assisted surgery, with 66% indicating that they planned to increase their use of the procedure in the next year. CONCLUSIONS: We found an overall increase in the use of and perceived indications for minimally invasive surgery in gynecologic oncology among SGO members. Endometrial cancer staging has become an accepted indication for laparoscopy. In addition, most respondents were planning on increasing their use of robotic assisted surgery in the next year.
“Vaginal robot-assisted radical hysterectomy (VRARH) after laparoscopic staging: feasibility and operative results.”
Oleszczuk, A., C. Kohler, et al. (2009).
Int J Med Robot 5(1): 38-44.
BACKGROUND: To describe a technique of vaginal robot-assisted radical hysterectomy (VRARH) that utilizes the advantages of a robotic system and eliminates the manipulation of cancer tissue. METHODS: A prospective study was performed for VRARH using the da Vinci robotic surgical system in 12 patients. The procedure was indicated in patients with cervical cancer stage FIGO IB1 after laparoscopic lymphadenectomy. A tumour-adapted vaginal cuff was created transvaginally. RESULTS: All operations were completed with minimal blood loss (mean 123 ml). The mean operative time including para-aortic lympadenectomy was 356 min, the vaginal cuff creation took 43 min and the radical robotic resection 68 min. No uterine manipulator was used. There were no bladder or bowel complications and no conversion to standard laparoscopy or laparotomy. CONCLUSIONS: The VRARH technique combines the advantages of the vaginal route and robotic laparoscopic surgery: tumour contamination is avoided and complications are minimized. This procedure could be superior to techniques described previously.
“Robotic radical hysterectomy: a new standard of care?”
Ramirez, P. T. (2009).
Future Oncol 5(1): 23-5.
“Current developments for pelvic exenteration in gynecologic oncology.”
Schneider, A., C. Kohler, et al. (2009).
Curr Opin Obstet Gynecol 21(1): 4-9.
PURPOSE OF REVIEW: The present review aims to update new techniques of pelvic exenteration including minimal invasive surgery, and discuss other aspects of this radical surgery, including worldwide differences. RECENT FINDINGS: Major advances are made since the first description of pelvic exenteration and the operation is still under evolution. Explorative laparoscopy prior to exenteration is a valuable alternative to laparotomy to elect candidates for pelvic exenteration. There are considerable differences with respect to indications, contraindications, preoperative staging and adjuvant therapy after exenteration in different countries. Advances in laparoscopic instruments also led to the laparoscopic exenteration. The main limiting step of the operation is urinary diversion. New techniques of laparoscopic-assisted and robotic-assisted techniques of urinary diversion have been reported that decrease the operation time. Vascularized muscle flaps are preferred by many surgeons to fill the empty pelvis and provide an acceptable vaginal reconstruction. J-pouch seems to be a safer technique than end-to-end coloanal anastomosis for bowel reconstruction. Developments in the bioengineering tissue for pelvic reconstruction are required. SUMMARY: Laparoscopy has the advantages of decreased blood loss, improved convalescence, lower incidence of wound infection and incisional hernia, short recovery periods, rapid return of bowel function, better pain control and improved cosmetics compared with laparotomy for pelvic exenteration. Magnification and improved visualization permits en-bloc dissection of tumor and good anastomosis technique. New techniques of urinary diversion, orthotopic neobladder and coloanal are promising.
“Robotic-assisted laparoscopic cerclage in a pregnant patient.”
Fechner, A. J., M. Alvarez, et al. (2009).
Am J Obstet Gynecol 200(2): e10-1.
A robotic-assisted laparoscopic technique for transabdominal cerclage placement could offer improvements over the traditional laparoscopic approach. A gravid female with no vaginal portion of the cervix underwent a robotic-assisted laparoscopic cerclage at 12 weeks’ gestation and ultimately delivered a healthy infant at term.
“Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy–a retrospective matched control study.”
Nezhat, C., O. Lavie, et al. (2009).
Fertil Steril 91(2): 556-9.
OBJECTIVE: Compare robotic-assisted laparoscopic myomectomy (RALM) to a matched control standard laparoscopic myomectomy (LM). DESIGN: A retrospective matched control study. SETTING: Private practice setting. PATIENT(S): Premenopausal and postmenopausal women who underwent either robotic-assisted or standard laparoscopic myomectomy. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Retrospective chart review was performed. Cases of laparoscopic robotic-assisted myomectomies were compared with a matched control group of standard LM. Comparisons were based on Fisher’s exact, Mann-Whitney, and exact chi-square tests. RESULT(S): Between January 2006 and August 2007, 15 consecutive RALMs were performed at our institution, compared with 35 matched control standard LMs. The two groups were matched by age, body mass index, parity, previous abdominopelvic surgery, size, number, and location of myomas. Mean surgical time for the RALM was 234 minutes (range 140-445) compared with 203 minutes (range 95-330) for standard LMs. Blood loss, hospitalization time, and postoperative complications were not significantly different. CONCLUSION(S): The RALM required a significant prolonged surgical time over LM. It appears that in the hands of a skilled laparoscopic surgeon, the RALM does not offer any major advantage. This technology, however, offers exciting potential applications while learning endoscopic surgery. Further studies are warranted to asses the utility of RALM for general gynecologic surgeons.
“Robotic anterior pelvic exenteration for bladder cancer in the female: outcomes and comparisons to their male counterparts.”
Pruthi, R. S., H. Stefaniak, et al. (2009).
J Laparoendosc Adv Surg Tech A 19(1): 23-7.
Abstract Background: Recent small case series have now been reported for robotic-assisted laparoscopic radical cystectomy. The majority of these series have reported techniques and outcomes in a predominantly male patient population. The application of such novel techniques to female cystectomy and anterior exenterative procedures has not been well documented and described. In this paper, we report our initial experience with robotic anterior pelvic exenteration in the female with bladder cancer evaluating perioperative and pathologic outcomes of this novel procedure and comparing the outcomes to those observed in their male counterparts. Methods: Fifty patients underwent a robotic radical cystectomy and extracorporeal diversion for clinically localized bladder cancer: 40 male patients (robotic radical cystoprostatetctomy) and 10 women (robotic anterior pelvic exenteration). Outcome measures evaluated in this series included operative variables, hospital recovery, pathologic outcomes, and complication rate. Results: Mean age of female patients was 68.4 years and of male patients was 62.8. Mean operating room time was 4.6 hours, and mean surgical blood loss was 215 mL. On surgical pathology, 5 patients were <=pT2, 3 patients pT3, and 2 patients N+. In no case was there a positive surgical margin, though in 1 case there was inadvertent entry into the bladder. Mean number of lymph nodes removed was 19 (range, 12-34). Mean time to flatus was 1.9 days, time to bowel movement 2.4 days, and time to discharge 4.9 days. These outcomes were comparable to the male patients, particularly the 20 male patients undergoing robotic radical cystoprostatectomy during the same time period. Conclusions: In our experience, the robotic anterior exenteration has been readily adapted to the surgical treatment of bladder cancer with similar outcomes to those observed in male patients undergoing a robotic radical cystoprostatectomy. The approach appears to achieve the clinical and oncologic goals of radical cystectomy in both the female and male patient.
“Case report: robotic-assisted laparoscopic ureterocalicostomy with long-term follow-up.”
Schimpf, M. O. and J. R. Wagner (2009).
J Endourol 23(2): 293-5.
BACKGROUND: Robotic-assisted laparoscopic surgery is being applied to a growing number of procedures. PATIENT AND METHODS: A 32-year-old woman with ureteropelvic obstruction underwent a robotic-assisted laparoscopic ureterocalicostomy in 2005. She had an uncomplicated surgery with minimal blood loss and post-operative course. RESULTS: Imaging done serially after surgery remained stable. She became pregnant about 2 years later and ultimately required percutaneous nephrostomy for flank pain and worsening hydronephrosis in the third trimester. Nephrostogram after delivery showed a patent anastomosis, and the nephrostomy tube was removed. CONCLUSIONS: Robotic-assisted laparoscopy is an option for patients who require ureterocalicostomy. Long-term outcome at 3 years is favorable.