Page 27 - WJOLS - World Journal of Laparoscopic Surgery

REVIEW ARTICLE
Role of Robotic Surgery in Gynecologic Oncology in India

R Anjali

AbstrAct
Aim: This article aimed to study the role of robotic surgery in gynecologic oncology in India over the past decade.
Background: Different randomized and observational, retrospective and prospective studies that met the eligibility criteria were included. Various
parameters were compared between robotic and laparoscopic surgeries. The different parameters evaluated in the studies were operative time,
estimated blood loss, hospital stay, complications, conversion rates, so on and so forth. Nodal yield, vaginal margin and paracervical clearance
were studied in a few of them. PubMed was the main search engine utilized for searching the study data.
Review results: After careful analysis of the data, it was noted that the complication rate, blood loss, and postsurgery hospitalization were
significantly lower with robotics, whereas some inconsistencies were noted regarding the operating time.
Conclusion: India is notably at the brink of a revolution. The need of the hour is to make this new surgically innovative technology accessible
to all—to the surgeons as well as the patients.
Clinical significance: Critical analysis of robotic surgeries in gynecology in Indian setting has been done. This would help in planning adoption
and training of this upcoming domain.
Keywords: Da vinci robotic surgical system, Gynecologic oncology, Robotic surgery.
World Journal of Laparoscopic Surgery (2018): 10.5005/jp-journals-10033-1345

IntroductIon Department of Obstetrics and Gynecology, Sapthagiri Institute of
In recent times, through robotic surgery, medical quality of care has Medical Sciences and Research Institute, Bengaluru, Karnataka, India
taken a giant leap towards the better though limited at present by Corresponding Author: R Anjali, Department of Obstetrics and
cost factor. Robotic surgery has superseded laparoscopic surgeries Gynecology, Sapthagiri Institute of Medical Sciences and Research
due to various reasons such as 3D vision, tremor filtering, precise Institute, Bengaluru, Karnataka, India, Phone: +91 8431974145, e-mail:
movements of the instruments with seven degrees of movement dr.anjaliramaswamy@gmail.com
and many others. The state-of-art da Vinci robotic surgical system How to cite this article: Anjali R. Role of Robotic Surgery in Gynecologic
(DRS) heralds the beginning of a new era which could possibly Oncology in India. World J Lap Surg 2018;11(3):135–137.

mean the end of laparoscopic and open surgeries as we know them. Source of support : Nil

There are innumerable robots in the USA alone with an Conflict of interest: None
exponential rise in their utilization rates. Their popularity has also
spread to Europe, Asia and Australia. Currently in India, robotic with seven degrees of freedom; so on and so forth. Owing to
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surgery is in the early developmental and adaptive phase. As per the aforementioned reasons, this master-slave surgical robot has
the data for this year, there are 19 robots in India—in New Delhi, widespread applications in all surgical fields, especially where
Gurugram, Mumbai, Chennai, Nadiad, Bengaluru, and Hyderabad. intracorporeal suturing is required as it provides unmatched
The All India Institute of Medical Sciences, New Delhi, has meticulous anatomy of the surgical field of interest. When a complex
contributed a lot to the progress in robotic surgery in our country. It condition is encountered in clinical practice, it is our general
was here that the first robotic prostatectomy in India was performed tendency to avoid MAS and proceed with open surgeries. This is
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in July 2006. From then on, the trend is catching on but financial where the robots step in and prove as a very valuable tool for a
constraint is the main limitation. The future prospects with new better outcome with minimal chances of complication.
upcoming robots do sound promising. From a patient’s point of view, owing to the higher cost one
may feel that it is indeed a marketing strategy. But there are many
robotIc surgery vs LApAroscopIc evidence-based studies that establish advantages to the patient
ApproAch without any element of doubt. DRS needs smaller incisions, has
lesser blood loss, shorter hospital stay and is associated with less
The major contributing factor to the unprecedented explosion in pain. 3
the use of robotic surgery is its unquestionable superiority over
conventional laparoscopic surgery. It basically overcomes most of
the limitations of laparoscopic surgery. It offers many advantages InItIAtIon of robotIc surgery
to the surgeon as well as the patient. Unlike laparoscopy (which has The DRS was brought into the market by Intuitive Surgical
a disheartening learning curve), open surgeons can easily switch Systems, Inc., and was US FDA cleared for urologic procedures in
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over to robotics due to its various advantages over other MAS 2001 and gynecologic surgery in 2005. Urologists were the first
(minimal access surgery). It offers a high degree of magnification; among the medical fraternity to accept this technology whole
has a surgeon-friendly profile with better ergonomics; and has heartedly; prostatectomy being the first surgery performed by
EndoWrist technology, which provides a whole range of movements them. Incidentally it still remains the most common procedure

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