Robotic Surgery in Gynecology

Abstract

Minimally invasive surgery (MIS) can be considered as the greatest surgical innovation over the past 30 years. It revolutionized surgical practice with well-proven advantages over traditional open surgery: reduced surgical trauma and incision-related complications, such as surgical-site infections, postoperative pain and hernia, reduced hospital stay, and improved cosmetic outcome. Nonetheless, proficiency in MIS can be technically challenging as conventional laparoscopy is associated with several limitations as the two-dimensional (2D) monitor reduction in-depth perception, camera instability, limited range of motion, and steep learning curves. The surgeon has a low force feedback, which allows simple gestures, respect for tissues, and more effective treatment of complications. Since the 1980s, several computer sciences and robotics projects have been set up to overcome the difficulties encountered with conventional laparoscopy, to augment the surgeon’s skills, achieve accuracy and high precision during complex surgery, and facilitate widespread of MIS. Surgical instruments are guided by haptic interfaces that replicate and filter hand movements. Robotically assisted technology offers advantages that include improved three-dimensional stereoscopic vision, wristed instruments that improve dexterity, and tremor canceling software that improves surgical precision.

Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

“…Robot-assisted laparoscopy has made progress in overcoming some of the important shortcomings of conventional laparoscopy by providing an ergonomic operating position, a stable magnified three-dimensional view, tremor filtering, motion scaling, and articulated or wristed instruments, allowing for precise tissue dissection and suturing [12,13]. By shortening the learning curve, these advantages may enable more surgeons to perform complex MAS procedures, and could extend the feasibility of MAS to a greater body of surgeons [2].…”

Robot-Assisted Vesico-Vaginal Fistula Repair: Our Technique and Review of the Literature

“…The fistula occurred after open surgical management for ovarian and uterine cancer, including hysterectomy, ovaryectomy, and omentectomy and cytoreductive peritoneomectomy. The fistula site was mainly the trigone and identified during cystoscopy near the mid-line [3] , left, and right urether meatus, respectively. The median fistula diameter was 5 mm (range 3-8 mm).…”

“…It is still debatable if there is an ideal time for repair. In the last decade, the number of minimal-invasive-surgery published series grew, showing a similar trend in the surgical management of this complication as for many other urological pathologies [2] .The advantages of using the da Vinci system for a surgery requiring reconstruction in deep pelvis are well known [3,4] . However, data supporting the use of robotic-assisted approach in managing VVF are still limited for considering it the standard of care [5] .…”

A prospective, single-arm study on the use of the da Vinci® Table Motion with the Trumpf TS7000dV operating table

“…The robotic platform provides a stable camera view to identify vessels, nerves and musculo-fascial structures and allows for counter traction under the surgeons' control, which together with Endo-Wrist enables fine and precise movements even in narrow spaces such as the pelvis [3].…”