Arch Gynecol Obstet (2014) 289:5–6 DOI 10.1007/s00404-013-3066-7

NEWS AND VIEWS

Robotic surgery in gynecology Pauline Wimberger • Axel Schindelhauer

Published online: 30 October 2013 Ó Springer-Verlag Berlin Heidelberg 2013

In Gynecology, minimally invasive surgery is present in more than 70 %. Advantages of laparoscopy in comparison to laparotomy are the small incisions, a better wound healing, less blood loss, earlier convalescence and a shorter hospital stay. Especially, elderly and multi-morbid oncologic patients with a higher risk for surgery profit from laparoscopic surgery, but conventional laparoscopy has limitations. To perform complex laparoscopic surgeries, high practical experience is necessary with a long learning curve. Duration of surgeries is often longer and performance can be exhausting using unhandy instruments. Because of only three degrees of freedom resulting in constricted mobility of the instruments, some surgical steps especially in very obese patients are not sufficiently possible. In these situations, computer- and robot-assisted laparoscopic surgery with four computer-assisted surgical arms is an innovation in Gynecology and in Gynecologic Oncology. The tridimensional view and the nearby unlimited mobility of the robotic instruments correspondent to the open human hand are the out-standing benefits of this technique.

P. Wimberger (&)  A. Schindelhauer Department of Gynecology and Obstetrics, Carl-Gustav Carus University Dresden, Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany e-mail: [email protected]

Robotic surgery enables more precise surgical interventions by 12-fold magnification and the precision of the instruments. Teaching and training of young colleagues reach a new dimension. Particularly, complex and extensive oncologic surgeries like nerve-sparing radical hysterectomy (total mesometrial resection, TMMR) in cervical cancer are sufficiently possible by minimally invasive robotic surgery. Further capabilities are complex surgery in deep infiltrating endometriosis and refertilisation of the tubes in case of unrequested childlessness, even in very obese patients. Long-time follow-up of oncologic surgical interventions with robotic surgery is still missing, but the data concerning the number of resected lymph nodes in endometrial cancer and cervical cancer suggest an equi-effectivity of robotic surgery in comparison to open surgery and classic laparoscopy. Published data show a higher number of resected lymph nodes in case of systematic lymphadenectomy in endometrial and cervical cancer for robotic surgery in comparison to laparotomy and to conventional laparoscopy [1]. In practical experience, risk factors like obesity play a decisive role how radical and by which access path the oncologic surgery will be performed. A mono-center prospective analysis of 1,000 gynecologic oncologic patients showed a decreased mortality in comparison to laparotomy [2]. In 377 patients with endometrial cancer, significantly more lymph nodes were resected with a decreased complication rate in comparison to a historic collective [2]. A meta-analysis documented less blood loss, shorter hospital stay, decreased complication rates and more resected lymph nodes for robotic surgery in comparison to laparotomy and conventional laparoscopy [3]. Our own experiences confirm these data that especially patients with cervical or endometrial cancer and multi-

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morbid and very obese patients benefit from robotic surgery. Of course, we may not conceal the high costs of the robotic instruments. Therefore, the dedication of robotic surgery is present in particular in gynecologic oncology and complex extensive surgical interventions like, for example, in advanced endometriosis, especially in deep infiltrating endometriosis. Our aim for the future is not only to use this new innovative technique in daily routine, but also to further enhance robotic surgery within centers and to prospectively evaluate complications, risks, costs and long-time followup. Prospective studies that compare robotic surgery with conventional laparoscopy and laparotomy are desirable, but funding of such surgical trials is very difficult.

Summary Advantages of robotic surgery are the tridimensional and the non-restrictive flexibility because of the seven freedom

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Arch Gynecol Obstet (2014) 289:5–6

degrees of the sophisticated instruments. These benefits are particularly present in case of complex oncologic surgeries like, for example, the nerve-sparing total mesometrial resection in cervical cancer and in early stage of endometrial cancer. Patients with extreme obesity and multimorbid women can profit extremely from this innovative new technique. Conflict of interest P. Wimberger received lecture fees from Intuitive Surgical, Inc. A. Schindelhauer had no conflict of interest.

References 1. Reza M, Maeso S, Blasco JA, Andradas E (2010) Meta-analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery. Br J Surg 97(12):1772–1783 2. Paley PJ, Veljovich DS, Shah CA, Everett EN, Bondurant AE, Drescher CW, Peters WA 3rd (2011) Surgical outcomes in gynecologic oncology in the era of robotics: analysis of first 1000 cases. Am J Obstetr Gynecol 204(6):551.e1–9 3. Cho JE, Nezhat FR (2009) Robotics and gynecologic oncology: review of the literature. J Minim Invasive Gynecol 16(6):669–681

Robotic surgery in gynecology.

Advantages of robotic surgery are the tridimensional and the non-restrictive flexibility because of the seven freedom degrees of the sophisticated ins...
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