Page 35 - Laparoscopic Surgery Online Journal

WJOLS

Robotic Gynecological Surgery: A Clinical Approach

USES OF ROBOTIC SURGERY The average hospital stay was 2 days, with a range of 1 to
3 days. 21
Several robotic systems are currently approved by the FDA
Robotic surgery is also used in gynecological oncology
for specific surgical procedures. The Zeus system and the
which is due to a great progression of robotic technology.
Da Vinci system have been used in many laparoscopic
In 2005, the first feasibility studies in both Europe and the
surgeries, including cholecystectomies, mitral valve repairs,
United States were published. The surgeon can mange many
radical prostatectomies, reversal of tubal ligations, in
malignancies by robotic surgery such as cervical,
addition to many gastrointestinal surgeries, nephrectomies
endometrial and ovarian cancer as well as pelvic lymph
and kidney transplants. The number and types of surgeries
nodes removal without port-site metastasis or recurrences
being performed with robots is increasing rapidly as these
which not found with a mean follow-up of 10 months. 22
system accepted by many institutions. Perhaps the most
In reproductive surgery, the robotic surgery is used to
notable use of these systems is in totally endoscopic coronary
19
artery grafting. The amount of data evaluated the robotic evaluate the cases of infertility; robotic myomectomy has
many advantages such like as decrease the risk of adhesion
surgery is growing rapidly, and the early data are promising.
and pelvic organ manipulation which affect the fertility.
Many studies have evaluated the feasibility of robot-assisted
Although the costs and operative times were higher in the
surgery. The studies also found the robot to be most useful
robotic myomectomy but the patients had significantly less
in intra-abdominal microsurgery or for manipulations in very
blood loss and did not require blood transfusions. Another
small spaces.
usage of robotic surgery in reproductive surgery is in tubal
Another use for robotic systems is in pediatric
reanastomosis which perform to treat the tubal blockage
laparoscopic surgery. Currently, laparoscopic pediatric
due to tubal pathology and this is considered one of
surgery is limited by an inability to perform precise
microsurgical procedures which can be performed by robotic
anastomoses of 2 to 15 ml. Although laparoscopic techniques
surgery. Robotic surgery also has a role in urogynecology.
may be used to treat infants with intestinal atresia,
Laparoscopic sacrocolpopexy is used as vaginal recons-
choledochal cysts, biliary atresia, and esophageal atresia in
tructive surgery, can be performed by robotic surgery in
term and preterm infants, it is not the standard approach
20
because of the technical difficulties. Despite many studies which the surgeons can perform the presacral dissection
laparoscopically, put the mesh, and intracorporeal
showing the feasibility of robotic surgery, there is still much
suturing, which has significant advantages to the robotic
to be desired. More high quality clinical trials need to be
23
approach. Table 2 shows summary of current applications
performed and much more experience needs to be obtained
of robotic surgery.
before the full potential of these systems can be realized.
One of the most important uses of robotic surgery is in
THE FUTURE OF THE ROBOTIC SURGERY
gynecological surgery. The surgeon can perform
hysterectomy which is the most important procedure in Robotic surgery is in its infancy. Many disadvantages will
gynecology robotic hysterectomy and is preferable than be resolved with the time. The surgeons will overcome the
laparoscopic, vaginal or abdominal hysterectomy. Operative obstacles such as malpractice liability, training requirements.
times ranged from 270 to 600 minutes, and blood loss ranged Many of current advantages in robotic assisted surgery
between 50 and 1,500 ml, with an average loss of 300 ml. ensure its continued development and expansion. One
Table 1: Advantages and disadvantages of conventional laparoscopic surgery vs robotic surgery
Conventional laparoscopy Robotic surgery
Advantages Well-developed technology 3D visualization
Affordable and available Improved dexterity
Proven efficacy 7º of freedom
Elimination of fulcrum effect
Elimination of physiologic tremors
Ability to scale motions
Microanastomosis possible
Telesurgery
Disadvantages Loss of touch sensation Very expensive
Compromised dexterity High startup cost
Limited degrees of motion May require extra staff to operate
The fulcrum effect
Amplification of physiologic tremors New technology
Loss of 3D visualization Unproven benefit

World Journal of Laparoscopic Surgery, September-December 2013;6(3):156-162 159