Robotic surgery in gynecology: A review of literature

Abstract

Background: Robotic surgery carries with it the potential to transform laparoscopic surgery by providing, for the 1 st time, instruments with distal ends that mimic the intricate movements of the human hand while at the same time providing the surgeon with a high-definition, three-dimensional view of the operative field. Objective: The objective of the study was to describe the clinical application of robotic surgery in benign gynecological conditions, as well as the components of the Da Vinci Si robotic system, analyzing the advantages and disadvantages of this type of surgical approach that it provides to the patient and in turn to the surgeon. Methods: Review of the literature in PubMed and UpToDate where the keywords of our review were searched. Inclusion criteria: articles of cases or series containing the sections of the application of robotic surgery in gynecology and clinical results. Results: We found 50 scientific articles that included in their titles the key words of our review. Twenty-two articles were discarded, 14 because they were inaccessible, 3 because they were published in bulletins without an impact factor, and 5 because no information was obtained about the researcher's results, their volume, visibility, and structure. A total of 28 articles were chosen for this review. Conclusions: Robotic surgery has evolved to be a separate field, with enormous potential for future development. The results show until now that this technology is applicable and capable of offering an adequate treatment to selected patients.

Surgeon experience, robotic perioperative outcomes, and complications in gynecology

“…Robotic surgery is a substantial breakthrough in the field of minimally invasive surgery, and this type of intervention has shown a large growth in the past decade 1 , 2 , 7 . There are more than 6,730 robots over 69 countries 2 , 3 .…”

“…In this 10-year period, the most frequent diagnosis for surgery was endometriosis, representing 381 (50.4%) cases. Previous studies have shown benefits in the use of robotics for the endometriosis treatment, given its extension, depth, and complexity 1 , 9 . Advantages go beyond ergonomics, with more precise identification of lesions, as confirmed by Mosbrucker et al showing a significantly higher rate of confirmed diagnosis in patients treated with robotic technology 9 .…”

“…Robotic surgery is currently on the rise and has been widely applied all over the world 1 . At present, there are more than 50,000 certified surgeons and more than 6,730 robots distributed across 69 countries 2 , 3 .…”

“…At present, there are more than 50,000 certified surgeons and more than 6,730 robots distributed across 69 countries 2 , 3 . Gynecology offers many opportunities for the development of innovative techniques due to the magnitude of benign and malignant diagnoses with surgical needs 1 , 4 . To date, 84 hospitals in Brazil have the robotic daVinci system and these institutions, as well as medical associations and regulatory entities, have been searching and working for the safety in the use of this technology and its association with good results for the patient 3 .…”

“…On this topic, we recently published an article on the importance of proctors in robotic gynecological procedures when surgeons are performing their first procedures, providing a learning curve without increasing risks to the patient 5 . But the literature is scarce, and there is no global credentialing rules to assure the best and safest outcomes to patients 1 , 4 , 6 . Barbash and Glied have recommended a minimum of 150–200 procedures for the surgeon to become skilled in the use of robotics, and Lenihan Jr described a shorter surgical time after 50 hysterectomies 7 , 8 .…”