da Vinci® Hysterectomy for Benign Conditions
Lenihan Jr JP, Kovanda C, Seshadri-Kreaden U. What is the Learning Curve for Robotic Assisted Gynecologic Surgery? Journal of Minimally Invasive Gynecology. 2008;15(5):589-94.
Study Objective: The purpose of this study was to estimate the learning curve when using the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) in benign gynecologic cases by a team of 2 gynecologic laparoscopists. Design: Retrospective case series (Canadian Task Force classification II-1). Setting: A private practice obstetrics/gynecology clinic. Patients: Patients requiring major benign gynecologic surgery who were candidates for a laparoscopic approach. Intervention: All patients who would have otherwise been offered a transabdominal or conventional laparoscopic procedure were offered the option of having their procedure performed laparoscopically with robotic assistance. Data that were collected included robot set-up times by the operative room staff, operative times for use of robot, total operative times, and perioperative outcome. We analyzed the learning curve defined as the number of cases required to stabilize operative time to perform the various procedures. Measurements and Main Results: One hundred thirteen patients were treated over a 22-month period with the da Vinci Surgical System. Most procedures were hysterectomies, whereas other gynecologic procedures included supracervical hysterectomy, laparoscopic vaginal assisted hysterectomy, myomectomy, sacrocolpopexy, and oophorectomy. Total operative times for hysterectomies studied sequentially stabilized at approximately 95 minutes after 50 cases. The decrease in robotic time did not depend on uterine size. The mean length of hospital stay was 24 hours, and return to normal activities averaged 2.8 weeks. Conclusions: Robotic assisted surgery is an enabling technology that allows gynecologic surgeons the ability to offer laparoscopic procedures to most of their patients. In the hands of surgeons with advanced laparoscopic skills, the learning curve to stabilize operative times for the various surgical procedures in women requiring benign gynecolologic interventions is 50 cases. © 2008 AAGL.
Payne TN, Dauterive FR. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 2008 May-Jun;15(3):286-91.
STUDY OBJECTIVE: To compare gynecologic practice and perioperative outcomes of patients undergoing total laparoscopic hysterectomy and robotic hysterectomy before and after implementation of a robotics program. DESIGN: A retrospective chart review of the last 200 consecutive hysterectomy cases completed before and after implementation of a robotics program (Canadian Task Force classification III). SETTING: Community hospital. PATIENTS: All patients requiring hysterectomy for benign indications between November 2004 and January 2007. INTERVENTIONS: Patients were candidates for total laparoscopic, abdominal, or vaginal hysterectomy before February 2006 and were candidates for total laparoscopic, total abdominal, total vaginal, or robotic-assisted laparoscopic hysterectomy after February 2006. Perioperative characteristics and trends were studied. MEASUREMENTS AND MAIN RESULTS: In all, 100 patients intended to be treated by laparoscopic hysterectomy before the implementation of a robotics program were compared with 100 patients treated by robotic hysterectomy after robot implementation. Overall the robotic cohort experienced longer operative times by an average of 27 minutes. The prerobotic cohort, however, when compared with the last 25 robotic cases had longer operative times (92.4 minutes [29.2], 95% CI 46.0-225.0 vs 78.7 minutes [29.5], 95% CI 66.0-91.2, p = .03). The mean blood loss in the prerobotic cohort was twice that of the robotic cohort (113 mL [85.9], 95% CI 95.9-130.1 vs 61.1 mL [60.9], 95% CI 48.9-73.2, p <.0001) and the mean length of hospital stay was half a day longer in the prerobotic cohort than in the robotic cohort (1.6 days [1.4], 95% CI 1.3-1.9 vs 1.1 days [0.7], 95% CI 1.0-1.3, p <.007). The incidence of adverse events was the same in both groups. The total number of exploratory laparotomies in the prerobotic cohort was significantly greater than in the robotic group (11% vs 0%). The rate of intraoperative conversions to total abdominal hysterectomy from laparoscopy was approximately 2-fold higher in the prerobotic cohort as compared with the robotic cohort (9% vs 4%). CONCLUSION: A higher likelihood of exploratory laparotomy for hysterectomy in the prerobotic cohort versus the robotic cohort and a higher likelihood of intraoperative conversion to laparotomy with the prerobotic cohort than with the robotic cohort existed. Reduced operative time, reduced blood loss, and shortened length of stay may be achieved in patients who are treated robotically versus a nonrobotic approach. Robotics may facilitate the minimally invasive treatment of patients while potentially reducing the rate of abdominal hysterectomies.
Visco AG, Advincula AP. Robotic Gynecologic Surgery. Obstet Gynecol 2008 Nov;112(6):1369-84.
The objective of this article is to review the recent adoption, experience, and applications of robot-assisted laparoscopy in gynecologic surgery. The use of robotics in gynecologic surgery is increasing in the United States. Robotic-assisted laparoscopic surgeries in gynecology include benign hysterectomy, myomectomy, tubal reanastomoses, radical hysterectomy, lymph node dissections, and sacrocolpopexies. The majority of the current literature includes case series of various robotic surgeries. Recently, comparative retrospective and prospective studies have demonstrated the feasibility of this particular type of surgery. Although individual studies vary, robot-assisted gynecologic surgery is often associated with longer operating room time but generally similar clinical outcomes, decreased blood loss, and shorter hospital stay. Robot-assisted gynecologic surgery will likely continue to develop as more gynecologic surgeons are trained and more patients seek minimally invasive surgical options. Well-designed, prospective studies with well-defined clinical, long-term outcomes, including complications, cost, pain, return to normal activity, and quality of life, are needed to fully assess the value of this new technology.
2008
A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice.
Payne TN, Dauterive FR.
J Minim Invasive Gynecol. 2008 May-Jun;15(3):286-91. Epub 2008 Mar 6.
In this study looking back on 100 patients treated before and 100 patients treated after the introduction of da Vinci Surgery into their practice, the surgeon authors found it was more likely that hysterectomy patients treated before da Vinci would need a large abdominal incision or would need conversion to open surgery. In other words, before da Vinci, the surgeons more often would have to "open up" patients during a minimally invasive surgery -- for example, when it was discovered that the patient's uterus size or adhesions from prior surgeries made a minimally invasive approach impossible to complete. Also in this study, using da Vinci Surgery also reduced the length of the surgery, reduced blood loss by half and significantly shortened length of stay in the hospital (from 1.6 to 1 day). This study concludes that da Vinci Surgery may help surgeons complete more minimally invasive hysterectomies and may help reduce the frequency of hysterectomy performed using large abdominal incisions. Abstract
2007
John F. Boggess, Paola A. Gehrig, Victoria Bae-Jump, Lisa Abaid, Aaron Shafer, Daniel Clarke-Pearson, Teresa L. Rutledge, John T. Soper, Linda Van Le, Wesley C. Fowler, Jr. Robotic Assistance Improves Minimally Invasive Surgery For Endometrial Cancer. Poster presented at SGO 2007. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill.
Senapati S, Advincula A. Surgical techniques: robot-assisted laparoscopic Myomectomy with the da Vinci ® surgical system. J Robotic Surg. 2007 March; 1(1): 69-74. Abstract . Full text .
2006
Advincula AP. Surgical techniques: robot-assisted laparoscopic hysterectomy with the da Vinci surgical system. Int J Med Robot. 2006 Dec;2(4):305-11. Abstract .
2005
Advincula AP, Reynolds RK. The use of robot-assisted laparoscopic hysterectomy in the patient with a scarred or obliterated anterior cul-de-sac. JSLS. 2005 Jul-Sep;9(3):287-91. Abstract .
Beste TM, Nelson KH, Daucher JA. Total laparoscopic hysterectomy utilizing a robotic surgical system. JSLS. 2005 Jan-Mar; 9(1): 13-15. Abstract .
Marchal F, Rauch P, Vandromme J, Laurent I, Lobontiu A, Ahcel B, Verhaeghe JL, Meistelman C, Degueldre M, Villemot JP, Guillemin F. Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients. Telerobotic-assisted laparoscopic hysterectomy for benign and oncologic pathologies: initial clinical experience with 30 patients. Surg Endosc. 2005 May 3 [Epub ahead of print] Abstract .
2004
Advincula AP, Falcone T. Laparoscopic robotic gynecologic surgery. Obstet Gynecol Clin North Am. 2004 Sep; 31(3): 599-609. Abstract .
Ferguson JL, Beste TM, Nelson KH, Daucher JA. Making the transition from standard gynecologic laparoscopy to robotic laparoscopy. JSLS. 2004 Oct-Dec; 8(4): 326-328. Abstract .
2002
Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C Jr. Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc. 2002 Sep; 16(9): 1271-1273. Abstract .
Falcone T, Steiner CP. Robotically assisted gynaecological surgery. Hum Fertil (Camb). 2002 May; 5(2): 72-74. Abstract .
While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.