Page 39 - Laparoscopic Surgery Online Journal

10.5005/jp-journals-10033-1205
Robotic vs Laparoscopic Hysterectomy: Is Robot Superior?
REVIEW ARTICLE
Robotic vs Laparoscopic Hysterectomy:
Is Robot Superior?

Mokoena Martins Mohosho

ABSTRACT 1st total laparoscopic hysterectomy was performed by Reich
14
The objective of this article is to reflect the current stand on et al in 1988. Since then, substantial improvements in optic
robotic vs laparoscopic hysterectomy. There are only few recent systems and instrumentation have made laparoscopic surgery
studies comparing robotic with laparoscopic hysterectomy and a lot more accurate, safer and probably easier to learn. As a
most are retrospective. Early studies found prolonged operating
times (e.g. 150.8 vs 114.4 minutes, p = 0.001) for robotic result of these technical advances during the past two
assisted than laparoscopic hysterectomy, 1,2 but this appears decades, complicated procedures like gynecologic cancer
to have been the result of a lack of experience with this new surgery, surgery of deep infiltrating endometriosis or
technology; the learning curve to reduce the robotic surgical time prolapse surgery today can be performed safely by
had median of 29 cases per surgeon. 10 Subsequent studies 7,11,13
reported operative durations which are comparable to laparoscopy.
conventional total laparoscopic hysterectomy, approximately A surgical robot is a computer-controlled device that
2 hours. 13,14 A minority of studies have reported that robotic- can be programmed to aid the positioning and manipulation
assisted is superior to conventional laparoscopic hysterectomy,
with reports of shorter operative duration, decreased blood loss, of surgical instruments. Surgical robotics is typically used
decreased rate of conversion to laparotomy, decreased use of in laparoscopy rather than open surgical approaches. Since
postoperative narcotic analgesia, and shorter hospital stay. 1,2,12 1980s, surgical robots have been developed to address the
Materials and methods: This involved the review of related limitations of laparoscopy, including two-dimensional
articles to robotic vs laparoscopic hysterectomy. The scope of visualization, incomplete articulation of instruments and
this review covered Medline, UpToDate, PubMed, Highwire 15
press, Da Vinci community, Google search engine. 12,13 ergonomic limitations.
Summary: Recent comparative studies have found that robotic
and conventional laparoscopic hysterectomy are essentially Features of Robotic Surgery
equivalent regarding surgical and clinical outcome. Operating The most important benefits of robot-assisted over
times are slightly higher and costs are significantly higher for 12,13
the robotic hysterectomy. conventional laparoscopy are:
• Superior visualization: Three-dimensional (3D) vs two-
Keywords: Robotic hysterectomy, Laparoscopic hysterectomy,
Hysterectomy, Minimal access surgery, Cost of robotic surgery, dimensional (2D) imaging from the operative field.
Robotic vs laparoscopic hysterectomy. • Mechanical improvements: A fulcrum effect is created
How to cite this article: Mohosho MM. Robotic vs Laparoscopic when rigid conventional instruments pass through the
Hysterectomy: Is Robot Superior? World J Lap Surg 2013;6(3): incision, thereby ultimately causing inversion of
163-166.
movement from the surgeon’s hand for the working end
Source of support: Nil of the instrument. When an instrument is introduced in
Conflict of interest: None declared a trocar, the abdominal wall is the fulcrum. Each time a
surgeon’s hand moves in one direction, the instrument
INTRODUCTION moves in the opposite direction. If a patient is obese,
Despite the presence of multiple nonsurgical alternatives there is more torque placed on the instrument and the
for treating uterine disease, hysterectomy continues to be rigid smaller caliber instruments as of laparoscope, may
one of the most commonly performed gynecologic fracture. Robotic instruments are less likely to break,
procedures. A minimal access approach to hysterectomy, thus, many surgeons prefer robot-assisted laparoscopy
which has several benefits over the traditional abdominal in obese patients. This is because all robotic instruments
technique, has already established a modest attraction in are 8 mm wide and attached to the robotic arms, which
gynecologic surgery. However, its practice and adoption is often attach to the robotic cannulas (trocars). The force
currently still limited. Factors that might explain this slow that the abdominal wall places on each instrument is
adoption include the learning curve associated with minimal sustained by the trocar and mechanical robotic arm. The
access surgery, lack of sufficient resident and fellow training, robotic laparoscope is 11 mm in diameter and is also
uneven availability of proper equipment, as well as a low introduced through a trocar, which is docked on the
level of physician reimbursement. 3,10,15 robotic scope arm. In contrast, conventional laparoscopy
Laparoscopic measures in gynecologic surgery have is performed with 3 or 5 mm instruments which are
been performed successfully in excess of 20 years now. The introduced through smaller trocars.
World Journal of Laparoscopic Surgery, September-December 2013;6(3):163-166 163