J Gynecol Oncol.  2011 Sep;22(3):196-202. 10.3802/jgo.2011.22.3.196.

The impact of robotic surgery on gynecologic oncology

• Nick AM
• Ramirez PT

• KMID: 2055708
• DOI: http://doi.org/10.3802/jgo.2011.22.3.196

Abstract

The objective of this article was to review the published scientific literature pertaining to robotic surgery and its applications in gynecologic malignancies and to summarize the impact of robotic surgery on the field of gynecologic oncology. Summarizing data from different gynecologic disease-sites, robotic-assisted surgery is safe, feasible, and demonstrates equivalent histopathologic and oncologic outcomes. In general, benefits to robotic surgery include decreased blood loss, fewer perioperative complications and decreased length of hospital stay. Disadvantages include accessibility to robot surgical systems, decreased haptic sensation and fixed cost as well as cost of disposable equipment. As robotic surgery becomes readily available it will be imperative to develop standardized training modalities. Further research is needed to validate the role of robotic surgery in the treatment of gynecologic malignancies.

Keyword

Gynecologic malignancies; Robotic surgery

MeSH Terms

Disposable Equipment
Length of Stay
Sensation

Reference

1. Barbash GI, Glied SA. New technology and health care costs: the case of robot-assisted surgery. N Engl J Med. 2010. 363:701–704.

2. Mabrouk M, Frumovitz M, Greer M, Sharma S, Schmeler KM, Soliman PT, et al. Trends in laparoscopic and robotic surgery among gynecologic oncologists: a survey update. Gynecol Oncol. 2009. 112:501–505.

3. Sert BM, Abeler VM. Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection: case report. Eur J Gynaecol Oncol. 2006. 27:531–533.

4. Sert B, Abeler V. Robotic radical hysterectomy in early-stage cervical carcinoma patients, comparing results with total laparoscopic radical hysterectomy cases. The future is now? Int J Med Robot. 2007. 3:224–228.

5. Kim YT, Kim SW, Hyung WJ, Lee SJ, Nam EJ, Lee WJ. Robotic radical hysterectomy with pelvic lymphadenectomy for cervical carcinoma: a pilot study. Gynecol Oncol. 2008. 108:312–316.

6. Nezhat FR, Datta MS, Liu C, Chuang L, Zakashansky K. Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer. JSLS. 2008. 12:227–237.

7. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, et al. A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol. 2008. 199:357.e1–357.e7.

8. Magrina JF, Kho RM, Weaver AL, Montero RP, Magtibay PM. Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol. 2008. 109:86–91.

9. Obermair A, Gebski V, Frumovitz M, Soliman PT, Schmeler KM, Levenback C, et al. A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. J Minim Invasive Gynecol. 2008. 15:584–588.

10. Wang YF, Chen GW, Li WS, Weng HN, Lu XG. Total laparoscopic radical trachelectomy with ascending branches of uterine arteries preservation. Chin Med J (Engl). 2011. 124:469–471.

11. Martin A, Torrent A. Laparoscopic nerve-sparing radical trachelectomy: surgical technique and outcome. J Minim Invasive Gynecol. 2010. 17:37–41.

12. Ramirez PT, Schmeler KM, Malpica A, Soliman PT. Safety and feasibility of robotic radical trachelectomy in patients with early-stage cervical cancer. Gynecol Oncol. 2010. 116:512–515.

13. Ramirez PT, Jhingran A, Macapinlac HA, Euscher ED, Munsell MF, Coleman RL, et al. Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings. Cancer. 2011. 117:1928–1934.

14. Magrina JF, Kho R, Montero RP, Magtibay PM, Pawlina W. Robotic extraperitoneal aortic lymphadenectomy: development of a technique. Gynecol Oncol. 2009. 113:32–35.

15. Vergote I, Pouseele B, Van Gorp T, Vanacker B, Leunen K, Cadron I, et al. Robotic retroperitoneal lower para-aortic lymphadenectomy in cervical carcinoma: first report on the technique used in 5 patients. Acta Obstet Gynecol Scand. 2008. 87:783–787.

16. Zullo F, Palomba S, Falbo A, Russo T, Mocciaro R, Tartaglia E, et al. Laparoscopic surgery vs laparotomy for early stage endometrial cancer: long-term data of a randomized controlled trial. Am J Obstet Gynecol. 2009. 200:296.e1–296.e9.

17. Zullo F, Palomba S, Russo T, Falbo A, Costantino M, Tolino A, et al. A prospective randomized comparison between laparoscopic and laparotomic approaches in women with early stage endometrial cancer: a focus on the quality of life. Am J Obstet Gynecol. 2005. 193:1344–1352.

18. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009. 27:5331–5336.

19. Tozzi R, Malur S, Koehler C, Schneider A. Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study. J Minim Invasive Gynecol. 2005. 12:130–136.

20. Paley PJ, Veljovich DS, Shah CA, Everett EN, Bondurant AE, Drescher CW, et al. Surgical outcomes in gynecologic oncology in the era of robotics: analysis of first 1000 cases. Am J Obstet Gynecol. 2011. 204:551.e1–551.e9.

21. Holloway RW, Ahmad S, DeNardis SA, Peterson LB, Sultana N, Bigsby GE 4th, et al. Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: analysis of surgical performance. Gynecol Oncol. 2009. 115:447–452.

22. Lim PC, Kang E, Park DH. Learning curve and surgical outcome for robotic-assisted hysterectomy with lymphadenectomy: case-matched controlled comparison with laparoscopy and laparotomy for treatment of endometrial cancer. J Minim Invasive Gynecol. 2010. 17:739–748.

23. Fauvet R, Boccara J, Dufournet C, Poncelet C, Darai E. Laparoscopic management of borderline ovarian tumors: results of a French multicenter study. Ann Oncol. 2005. 16:403–410.

24. Tozzi R, Kohler C, Ferrara A, Schneider A. Laparoscopic treatment of early ovarian cancer: surgical and survival outcomes. Gynecol Oncol. 2004. 93:199–203.

25. Spirtos NM, Eisekop SM, Boike G, Schlaerth JB, Cappellari JO. Laparoscopic staging in patients with incompletely staged cancers of the uterus, ovary, fallopian tube, and primary peritoneum: a Gynecologic Oncology Group (GOG) study. Am J Obstet Gynecol. 2005. 193:1645–1649.

26. Nezhat FR, DeNoble SM, Liu CS, Cho JE, Brown DN, Chuang L, et al. The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced stage ovarian, fallopian tube, and primary peritoneal cancers. JSLS. 2010. 14:155–168.

27. Magrina JF, Zanagnolo V, Noble BN, Kho RM, Magtibay P. Robotic approach for ovarian cancer: perioperative and survival results and comparison with laparoscopy and laparotomy. Gynecol Oncol. 2011. 121:100–105.

28. Barnett JC, Judd JP, Wu JM, Scales CD Jr, Myers ER, Havrilesky LJ. Cost comparison among robotic, laparoscopic, and open hysterectomy for endometrial cancer. Obstet Gynecol. 2010. 116:685–693.

29. Frumovitz M, Soliman PT, Greer M, Schmeler KM, Moroney J, Bodurka DC, et al. Laparoscopy training in gynecologic oncology fellowship programs. Gynecol Oncol. 2008. 111:197–201.

30. Geller EJ, Schuler KM, Boggess JF. Robotic surgical training program in gynecology: how to train residents and fellows. J Minim Invasive Gynecol. 2011. 18:224–229.

31. Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 2009. (1):CD006575.

32. Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard T, Schouenborg L, Ottosen C, et al. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ. 2009. 338:b1802.