Da Vinci SP Single-Port Robotic Surgery in Gynecologic Tumors: Single Surgeon’s Initial Experience with 100 Cases

Abstract

Purpose To report preliminary experience of single-port robotic surgery using the da Vinci SP surgical system in gynecologic tumors. Materials and Methods This was a retrospective study on 100 consecutive patients who underwent da Vinci SP single-port robotic surgery between November 2018 and January 2021. All procedures were performed by an experienced gynecologic surgeon using a single 2.5-cm umbilical incision. Results Of the 100 cases, the procedures included myomectomy (n=76), hysterectomy (n=2), endometrial cancer surgical staging (n=14), radical hysterectomy (n=3), radical trachelectomy (n=3), and ovarian cystectomy (n=2). None of the cases was converted to robotic multiport or open surgery. The median docking time was 5.0 minutes [interquartile range (IQR), 3.0–7.0], the median console time was 107.5 minutes (IQR, 78.7–155.8), and the median total operation time was 250.0 minutes (IQR, 215.0–310.0). The median estimated blood loss was 50.0 mL (IQR, 30.0–100.0), and the median change in hemoglobin level was 0.8 g/dL (IQR, 0.3–1.3). The median pain scores rated on a numerical rating scale immediately after and at 6, 12, and 24 hours after surgery were 5, 2, 2, and 2, respectively. The mean duration of postoperative hospitalization was 2.8 days. Conclusion Da Vinci SP single-port robotic surgery was successfully performed in various gynecologic tumors without significant complications. Therefore, this surgical system could be applied in patients who want precise gynecologic surgery while minimizing surgical incision.

A prospective phase II clinical trial/IDEAL Stage 2a series of single‐port robotic colorectal surgery for abdominal and transanal cases

“…Further, the surgeon can perform multi-quadrant surgery without repositioning the operating room table and almost no clashing of the instruments. Similar favourable ergonomics, positioning and outcomes have been reported using SP robotics in thoracic, hernia, gynaecological and urological surgery[38][39][40][41].This work adds to the literature as there are few reports of SP robotic CRS. All published work has very small numbers with no follow-up, showing only initial safety and feasibility.…”

New Robotic Platforms for Gynecology. Are We Achieving One of the Golden Goals?

“…Preclinical studies have used the SS platform to perform a variety of gynecological surgeries in porcine and cadaveric models using an umbilical approach [68]. The clinical studies showed the feasibility, safety, and effectiveness of the SS and SP® platforms in the performance of a wider variety of benign and malignant gynecological procedures, enrolling an increasing number of patients [69][70][71][72][73][74][75][76][77][78].…”

“…The introduction of bipolar instruments [71], wristed needle drivers [79], and SS ports able to accommodate the SP® cannula, and three other laparoscopic instruments at the same time represented improvements [78]. Important studies comparing SS against Multi-port and SS against SP® showed less post-operative pain, comparable surgical outcomes, shorter postoperative hospital discharge, cost reduction in surgical instruments, total hospitalization cost, and higher patient satisfaction [80][81][82].…”

“…In all clinical studies performed with Da Vinci SS [72][73][74][76][77][78][105][106][107][108][109][110][111], Versius® and Senhance® initially treated benign gynecological diseases and progressively treated pre-malignant [26,33,34,45,46,48,54,55,60,112], and malignant diseases from the moment they felt comfortable with its use [31,33,45,54,61]. In addition, for the development of Hominis®, several gynecological surgeries were performed to treat non-malignant diseases [87,88], and EDGE and Flex® did not report any clinical studies.…”

Da Vinci SP Robotic Surgery for Cervical Cancer FIGO 2018 Stage IA-IB: A Pilot Study

“…Its dualjointed robotic instruments enable freedom of movements within more con ned space, and works hand in hand with the all-improved endoscopic camera [10,11]. Da Vinci SP technology is widely incorporated in urology [10] and benign gynecology [11,12], with no study of its application in gynecologic oncology speci cally for cervical cancer till date. The study aimed to present the rst clinical experience and surgical outcome of robotic surgery with da Vinci SP for cervical cancer stage IA-IB.…”