Obstet Gynecol Sci.  2019 May;62(3):149-156. 10.5468/ogs.2019.62.3.149.

Robotic single-site staging operation for early-stage endometrial cancer: initial experience at a single institution

Affiliations
  • 1Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea. c0035@dsmc.or.kr, hope2014@dsmc.or.kr

Abstract


OBJECTIVE
The aims of this study were to introduce surgical guidelines, and to evaluate the feasibility and safety of a robotic single-site staging (RSSS) operation for early-stage endometrial cancer.
METHODS
Patients with a preoperative diagnosis of endometrial cancer (International Federation of Gynecology and Obstetrics stages IA to IB) from endometrial curettage and preoperative imaging studies were selected at Dongsan Medical Center from March 2014 to November 2015. All surgical procedures, including hysterectomy, salpingo-oophorectomy, bilateral pelvic node dissection, and cytology aspiration, were performed by robotic single-site instruments (da Vinci Si® surgical system; Intuitive Surgical, Sunnyvale, CA, USA).
RESULTS
A total of 15 women with early-stage endometrial cancer underwent the RSSS operation. The median patient age and body mass index were 53 years (range, 37-70 years) and 25.4 kg/m2 (range, 18.3-46.4 kg/m2). The median docking time, console time, and total operative time were 8 minutes (range, 4-15 minutes), 75 minutes (range, 55-115 minutes), and 155 minutes (range, 125-190 minutes), respectively. The median retrieval of both pelvic lymph nodes was 9 (range, 6-15). There were no conversions to laparoscopy or laparotomy.
CONCLUSION
The RSSS operation is feasible and safe in patients with early-stage endometrial cancer. In this study, operative times were reasonable, and the surgical procedure was well-tolerated by the patients. Further evaluation of patients with early-stage endometrial cancer should be performed in large-scale comparative studies using the laparoendoscopic, single-site staging operation to confirm the safety and benefits of the RSSS operation for early-stage endometrial cancer.

Keyword

Single site; Single port; Robotic; Staging operation; Endometrial cancer

MeSH Terms

Body Mass Index
Curettage
Diagnosis
Endometrial Neoplasms*
Female
Gynecology
Humans
Hysterectomy
Laparoscopy
Laparotomy
Lymph Nodes
Obstetrics
Operative Time

Figure

  • Fig. 1 Full view after completion of docking.

  • Fig. 2 (A) Careful dissection of the lymph nodes away from the ureter and vessels accomplished by the monopolar hook and the fenestrated bipolar grasper at the retroperitoneal space. (B) Completion of vagina cuff repair by continuous suture of V-Loc™ (Covidien, Minneapolis, MN, USA). (C) Full view after completion of full staging operation.

  • Fig. 3 Total operative time by chronological procedure number. RSSS, robotic single-site staging.

  • Fig. 4 (A) Safe dissection of the retroperitoneal space by unipolar hook which a tip of the unipolar hook faces upwards by rotation. (B) Dissected nodes as en bloc. (C) Careful coagulation of the small branches of vessels by the bipolar grasper to decrease any unnecessary bleeding.


Cited by  1 articles

Robotic surgery in Gynecology: the present and the future
JungYoon Park, SeongEun Bak, Jae-Yen Song, Youn-Jee Chung, Gen Yuki, Su Jeong Lee, Jisu Mun, Mee-Ran Kim
Obstet Gynecol Sci. 2023;66(6):518-528.    doi: 10.5468/ogs.23132.


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