J Gynecol Oncol.  2009 Sep;20(3):137-144. 10.3802/jgo.2009.20.3.137.

Recent advances of robotic surgery and single port laparoscopy in gynecologic oncology

• Jung YW
• Kim SW
• Kim YT

• KMID: 2173444
• DOI: http://doi.org/10.3802/jgo.2009.20.3.137

Abstract

Two innovative approaches in minimally invasive surgery that have been introduced recently are the da Vinci robotic platform and single port laparoscopic surgery (SPLS). Robotic surgery has many advantages such as 3-dimensional view, the wrist like motion of the robotic arm and ergonomically comfortable position for the surgeon. Numerous literatures have demonstrated the feasibility of robotic surgery in gynecologic oncology. However, further research should be performed to demonstrate the superiority of robotic surgery compared to conventional laparoscopy. Additionally, cost reduction of robotic surgery is needed to adopt robotic surgery into gynecologic oncology worldwide. SPLS has several possible benefits including reduced operative complications, reduced postoperative pain, and better cosmetic results compared to conventional laparoscopy. Although several authors have indicated that SPLS is a feasible approach for gynecologic surgery, there have been few reports demonstrating the potential advantages over conventional laparoscopy. Moreover, technical difficulties of SPLS still exist. Therefore, the advantages of a single port approach compared to conventional laparoscope should be evaluated with comparative study, and further technologic development for SPLS is also needed. These two progressive technologies take the lead in the development of MIS and further studies should be performed to evaluate the benefits of robot surgery and SPLS.

Keyword

Minimal surgical procedure; Endometrial neoplasm; Cervical neoplasm; Laparoscopic surgery

MeSH Terms

Arm
Cosmetics
Endometrial Neoplasms
Female
Gynecologic Surgical Procedures
Laparoscopes
Laparoscopy
Pain, Postoperative
Surgical Procedures, Minimally Invasive
Uterine Cervical Neoplasms
Wrist
Cosmetics

Figure

• 

  Fig. 1 The da Vinci surgical system. (A) Surgical console, (B) Robotic cart, (C) Vision cart, (D) Three dimensional vision system with endoscope, (E) Endowrist.

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  Fig. 2 Single port laparoscopic surgery. (A) A single 3-channel port using a wound retractor, a surgical glove, and three conventional laparoscopic trocars, (B) Postoperative wound, (C) Long endoscope.

Reference

1. Hulka JF. Current status of elective sterilization in the United States. Fertil Steril. 1977. 28:515–520.

2. Karel Čapek. Wikipedia: The Free Encycolpedia [Internet]. cited 2009 Aug 25. San Francisco: Wikimedia Foundation;Available from: http://en.wikipedia.org/wiki/Karel_%C4%8Capek.

3. Satava RM. Robotic surgery: from past to future--a personal journey. Surg Clin North Am. 2003. 83:1491–1500.

4. Bann S, Khan M, Hernandez J, Munz Y, Moorthy K, Datta V, et al. Robotics in surgery. J Am Coll Surg. 2003. 196:784–795.

5. Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, et al. Transatlantic robot-assisted telesurgery. Nature. 2001. 413:379–380.

6. Romano JA, Lam DM, Moses GR, Gilbert GR, Marchessault R. The future of military medicine has not arrived yet, but we can see it from here. Telemed J E Health. 2006. 12:417–425.

7. Kim YT, Kim SW, Yoon BS, Nahm EJ, Hur HW, Kim SH, et al. Robot-assisted total laparoscopic hysterectomy: initial experience in Korea. Korean J Obstet Gynecol. 2006. 49:2620–2625.

8. Ministry for Heath Welfare and Family Affairs. Annual report of cancer incidence (2005) and survival (1993-2005) in Korea. 2008. Seoul: Ministry for Heath Welfare and Family Affairs.

9. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006. 56:106–130.

10. 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.

11. Persson J, Reynisson P, Borgfeldt C, Kannisto P, Lindahl B, Bossmar T. Robot assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy with short and long term morbidity data. Gynecol Oncol. 2009. 113:185–190.

12. Lowe MP, Chamberlain DH, Kamelle SA, Johnson PR, Tillmanns TD. A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer. Gynecol Oncol. 2009. 113:191–194.

13. Estape R, Lambrou N, Diaz R, Estape E, Dunkin N, Rivera A. A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy. Gynecol Oncol. 2009. 113:357–361.

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

15. Fanning J, Fenton B, Purohit M. Robotic radical hysterectomy. Am J Obstet Gynecol. 2008. 198:649.e1–649.e4.

16. 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.

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

18. Maggioni A, Minig L, Zanagnolo V, Peiretti M, Sanguineti F, Bocciolone L, et al. Robotic approach for cervical cancer: comparison with laparotomy: a case control study. Gynecol Oncol. 2009. 115:60–64.

19. Bell MC, Torgerson J, Seshadri-Kreaden U, Suttle AW, Hunt S. Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol. 2008. 111:407–411.

20. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, et al. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008. 199:360–369.

21. DeNardis SA, Holloway RW, Bigsby GE, Pikaart DP, Ahmad S, Finkler NJ. Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol. 2008. 111:412–417.

22. Lowe MP, Johnson PR, Kamelle SA, Kumar S, Chamberlain DH, Tillmanns TD. A multiinstitutional experience with robotic-assisted hysterectomy with staging for endometrial cancer. Obstet Gynecol. 2009. 114:236–243.

23. Peiretti M, Zanagnolo V, Bocciolone L, Landoni F, Colombo N, Minig L, et al. Robotic surgery: changing the surgical approach for endometrial cancer in a referral cancer center. J Minim Invasive Gynecol. 2009. 16:427–431.

24. Seamon LG, Cohn DE, Henretta MS, Kim KH, Carlson MJ, Phillips GS, et al. Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol. 2009. 113:36–41.

25. Seamon LG, Cohn DE, Richardson DL, Valmadre S, Carlson MJ, Phillips GS, et al. Robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Obstet Gynecol. 2008. 112:1207–1213.

26. Veljovich DS, Paley PJ, Drescher CW, Everett EN, Shah C, Peters WA. Robotic surgery in gynecologic oncology: program initiation and outcomes after the first year with comparison with laparotomy for endometrial cancer staging. Am J Obstet Gynecol. 2008. 198:679.e1–679.e9.

27. Seamon LG, Bryant SA, Rheaume PS, Kimball KJ, Huh WK, Fowler JM, et al. Comprehensive surgical staging for endometrial cancer in obese patients: comparing robotics and laparotomy. Obstet Gynecol. 2009. 114:16–21.

28. Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A, Boggess JF. What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol. 2008. 111:41–45.

29. Childers JM, Brzechffa PR, Hatch KD, Surwit EA. Laparoscopically assisted surgical staging (LASS) of endometrial cancer. Gynecol Oncol. 1993. 51:33–38.

30. Cho YH, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Laparoscopic management of early uterine cancer: 10-year experience in Asan Medical Center. Gynecol Oncol. 2007. 106:585–590.

31. Malzoni M, Tinelli R, Cosentino F, Perone C, Rasile M, Iuzzolino D, et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study. Gynecol Oncol. 2009. 112:126–133.

32. Malzoni M, Tinelli R, Cosentino F, Fusco A, Malzoni C. Total laparoscopic radical hysterectomy versus abdominal radical hysterectomy with lymphadenectomy in patients with early cervical cancer: our experience. Ann Surg Oncol. 2009. 16:1316–1323.

33. Chen Y, Xu H, Li Y, Wang D, Li J, Yuan J, et al. The outcome of laparoscopic radical hysterectomy and lymphadenectomy for cervical cancer: a prospective analysis of 295 patients. Ann Surg Oncol. 2008. 15:2847–2855.

34. 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.

35. Lee TS, Kim JW, Kim SH, Seong SJ, Song E, Kim J, et al. Surgical practice patterns in endometrial cancer: results of the Korean Gynecologic Oncology Group survey. J Gynecol Oncol. 2009. 20:107–112.

36. Seamon LG, Fowler JM, Richardson DL, Carlson MJ, Valmadre S, Phillips GS, et al. A detailed analysis of the learning curve: robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Gynecol Oncol. 2009. 114:162–167.

37. Mendivil A, Holloway RW, Boggess JF. Emergence of robotic assisted surgery in gynecologic oncology: American perspective. Gynecol Oncol. 2009. 114:S24–S31.

38. Chung SM, Jung YW, Lee SH, Nam EJ, Kim SW, Kim JH, et al. Cost-effectiveness analysis of hysterectomy via laparotomy, laparoscopy and robotic assisted laparoscopy [abstract]. J Gynecol Oncol. 2009. 20:Suppl 1. 150S.

39. Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg. 2004. 139:1248–1256.

40. Seamon LG, Backes F, Resnick K, Cohn DE. Robotic trocar site small bowel evisceration after gynecologic cancer surgery. Obstet Gynecol. 2008. 112:462–464.

41. Wheeless CR. Outpatient tubal sterilization. Obstet Gynecol. 1970. 36:208–211.

42. Quinones GR, Alvarado DA, Ley Ch E. Tubal ligation using Yoon's ring. Ginecol Obstet Mex. 1976. 40:127–136.

43. Pelosi MA. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N J Med. 1991. 88:721–726.

44. Ghezzi F, Cromi A, Fasola M, Bolis P. One-trocar salpingectomy for the treatment of tubal pregnancy: a 'marionette-like' technique. BJOG. 2005. 112:1417–1419.

45. Romanelli JR, Earle DB. Single-port laparoscopic surgery: an overview. Surg Endosc. 2009. 23:1419–1427.

46. Lim MC, Kim TJ, Kang S, Bae DS, Park SY, Seo SS. Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for adnexal tumors. Surg Endosc. Epub 2009 Apr 3.

47. Lee Y, Kim T, Kim CJ, Kang H, Choi CH, Lee J, et al. Single-port access laparoscopic-assisted vaginal hysterectomy: a novel method with a wound retractor and a glove. J Minim Invasive Gynecol. 2009. 16:450–453.

48. Fader AN, Escobar PF. Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report. Gynecol Oncol. 2009. 114:157–161.