da Vinci® Hysterectomy for Early Stage Gynecological Cancer
Boggess JF. Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm J Robotic Surg. 2007 March; 1(1): 69-74. Abstract . Full text .
Aaron Shafer, John F. Boggess, Paola Gehrig, Victoria Bae-Jump, Lisa Abaid, Daniel Clarke-Pearson, Wesley C. Fowler Jr., Teresa L. Rutledge, John Soper, Linda Van Le. Type III radical hysterectomy for obese women with cervical carcinoma: Robotic versus open. Abstract presented at SGO 2007. University of North Carolina, Chapel Hill, NC.
Lynn D. Kowalski, MD, Camille A. Falkner, MD, Stephanie A. Wishnev, MD Nevada Surgery and Cancer Care 1 Sunrise Hospital and Medical Center, Las Vegas, NV. Incorporation of Robotics into a Gynecologic Oncology Practice: The First 100 Cases. Poster presented at SGO 2007.
da Vinci Myomectomy
Advincula AP, Xu X, Goudeau St, Ransom SB. Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: A comparison of short-term surgical outcomes and immediate costs. J Minim Invasive Gynecol2007 Nov-Dec;14(6):698-705.
STUDY OBJECTIVE: To compare surgical outcomes of myomectomy by robot-assisted laparoscopy with those performed by traditional laparotomy and to analyze the financial impact of these 2 approaches. DESIGN: Retrospective case-matched analysis (Canadian Task Force classification III). SETTING: University teaching hospital. PATIENTS: A total of 58 patients with symptomatic leiomyomata. INTERVENTION: Myomectomy by robot-assisted laparoscopy or traditional laparotomy was administered. MEASUREMENTS AND MAIN RESULTS: An equal number of case-matched patients based on age, body mass index, and myoma weight were analyzed in each group. Among these 3 variables, there were no statistically significant differences between the robotic and laparotomy groups. Mean age was 36.59 +/- 4.93 years (95% CI 34.71-38.46 years) versus 34.86 +/- 4.41 years (95% CI 33.18-36.54 years), mean body mass index was 25.22 +/- 3.85 kg/m(2) (90% central range [CR] 20.30-31.20 kg/m(2)) versus 28.3 +/- 6.95 kg/m(2) (90% CR 21.50-42.80 kg/m(2)), and mean myoma weight was 227.86 +/- 247.54 g (90% CR 11.60-680.00 g) versus 223.76 +/- 228.28 g (90% CR 11.50-660.00 g), respectively. Patients with robot-assisted laparoscopic myomectomy had decreased estimated blood loss (mean 195.69 +/- 228.55 mL [90% CR 50.00-700.00 mL] vs mean 364.66 +/- 473.28 mL [90% CR 75.00-1550.00 mL]) and length of stay (mean 1.48 +/- 0.95 days [90% CR 1.00-3.00 days] vs mean 3.62 +/- 1.50 days [90% CR 3.00-8.00 days]) when compared with the laparotomy group. Both of these differences were statistically significant at p <.05. Operative times were significantly longer in the robotic group: mean 231.38 +/- 85.10 minutes (95% CI 199.01-263.75 minutes) versus mean 154.41 +/- 43.14 minutes (95% CI 138.00-170.82 minutes, p <.05) in the laparotomy group. Complication rates were higher in the laparotomy group. Professional charges (mean $5946.48 +/- $1447.17 [90% CR $4034.46-$8937.00] vs mean $4664.48 +/- $642.11 [90% CR $3944.36-$6010.90, p <.0002]) and hospital charges (mean $30084.20 +/- $6689.29 [90% CR $22939.81-$45588.22] vs mean $13400.62 +/- $7747.26 [90% CR $8703.20-$26771.22, p <.0001]) were statistically higher for the robotic group. Although professional reimbursement was not significantly different between groups (mean $2263.02 +/- $1354.97 [90% CR $0.00- $4831.08] versus mean $1841.99 +/- $827.51 [90% CR $0.00-$3376.97, p = .2831]), mean hospital reimbursement rates for the robotic group were significantly higher: $13181.39 +/- $10752.00 (90% CR $1081.76-$37396.03) versus $7015.24 +/- $3467.97 (90% CR $2492.48-$10394.83, p = .0372). CONCLUSION: As a new technology, it is not unexpected that a robotic approach to myomectomy costs more than a traditional laparotomy. On the other hand, decreased estimated blood loss, complication rates, and length of stay with the robotic approach in the end may prove to have a significant societal benefit that will outweigh upfront financial impact.
Delotte J, Karimdjee B, Bouaziz J, Trastour C, Bernard JL, Benchimol D, Bongain A. Feasibility and preliminary experiment of a routine use of Da-Vinci S® in fertility surgery. Journal de Gynécologie Obstétrique et Biologie de la Reproduction 2008 Dec;37(8):753-7. Epub 2008 Oct 26
Objectives: The goal of our study is to evaluate the use of Da-Vinci S® in the field of fertility laparoscopic surgery. Materials and methods: Ten successive patients were included for a laparoscopic fertility surgery using the Da-Vinci S®. Surgical feasibility, operating time, length of hospital stay and postoperative complications have been analyzed. Results: All procedures have been completed using Da-Vinci S®. Conclusion: In our preliminary surgical experience, the Da-Vinci S® can be technically used in the field of fertility surgery. © 2008 Elsevier Masson SAS. All rights reserved.
Pitter MC, Anderson P, Blissett A, Pemberton N. Robotic-assisted gynaecological surgery-establishing training criteria; minimizing operative time and blood loss. Int J Med Robot2008 Jun;4(2):114-20.
BACKGROUND: The objective was an evaluation of operative time and estimated blood loss (EBL) as a function of experience in gynaecological robotic surgery. METHOD: A retrospective analysis of 40 consecutive cases (approximately one case/week) over a 1 year period using the da Vinci) robotic system was performed, using data from two institutions, Newark Beth Israel Medical Center and Hackensack University Medical Center. Information was obtained from a single surgeon. Among the 40 cases there were 17 hysterectomies and 23 myomectomies. Each patient met the criteria of benign disease. In each institution, a da Vinci) system using three instrument arms and a camera arm was employed for every operation. RESULTS: Tests of differences in means were performed to compare the two groups. In group I (cases 1-20) the mean uterine volume was 863.0 cc and was similar to Group II (cases 21-40) at 632.6 cc. There was no significant difference between the groups when comparing blood loss; means were 86 cc for group I and 62.5 cc for group II. Operative time between groups, however, showed a significant difference (mean of 211.8 min for group 1 compared to 151 min for group 2; p < 0.05) and console time demonstrated a similar trend (mean for group 1 was 159.8 min compared to 90.8 min for group 2; p < 0.05). There were no conversions to laparotomy. Body mass index (BMI) and prior abdominal surgery were not significantly different. Multivariate regressions on operative time and EBL were performed, controlling for uterine weight and volume. The effect of experience on operative time was significant and negative; the coefficient on EBL was not significant. CONCLUSION: This study demonstrates statistical improvement in operative time after the first 20 cases for a single surgeon. This information could be used to establish criteria for training surgeons.
Advincula AP, Song A, Burke W, Reynolds RK. Preliminary experience with robot-assisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 2004 Nov;11(4):511-8. Abstract .
Bocca S, Stadtmauer L, Oehninger S. Uncomplicated full term pregnancy after da Vinci-assisted laparoscopic myomectomy. Reprod Biomed Online. 2007 Feb;14(2):246-9. Abstract .
Dharia SP, Falcone T. Robotics in reproductive medicine. Fertil Steril. 2005 Jul;84(1):1-11. Review. Abstract .
da Vinci Sacrocolpopexy
Geller EJ, Siddiqui NY, Wu JM, Visco AG. Short-Term Outcomes of Robotic Sacrocolpopexy Compared With Abdominal Sacrocolpopexy. Obstet Gynecol2008 Nov;112(6):1201-6.
OBJECTIVE: To compare short-term outcomes of robotic sacrocolpopexy with abdominal sacrocolpopexy for vaginal vault prolapse. METHODS: We conducted a retrospective cohort study comparing robotic to abdominal sacrocolpopexy with placement of permanent mesh. The primary outcome was vaginal vault support on 6-week postoperative pelvic organ prolapse quantification (POP-Q) system examination. Secondary outcomes included blood loss, operative time, length of stay, blood transfusion, pulmonary embolus, gastrointestinal or genitourinary tract injury, ileus, bowel obstruction, postoperative fever, pneumonia, wound infection, and urinary retention. RESULTS: The analysis included 178 patients (73 robotic and 105 abdominal sacrocolpopexy). There were no differences in age, race, or body mass index. Robotic sacrocolpopexy showed slight improvement on POP-Q "C" point (-9 compared with -8, P=.008) when compared with abdominal sacrocolpopexy and was associated with less blood loss (103+/-96 mL compared with 255+/-155 mL, P<.001), longer total operative time (328+/-55 minutes compared with 225+/-61 minutes, P<.001), shorter length of stay (1.3+/-0.8 days compared with 2.7+/-1.4 days, P<.001), and a higher incidence of postoperative fever (4.1% compared with 0.0%, P=.04). There were no differences in other secondary outcomes. Operative time remained significantly greater in the robotic group (P<.001), and estimated blood loss remained lower (P<.001) when controlling for possible confounders. CONCLUSION: Robotic sacrocolpopexy demonstrated similar short-term vaginal vault support compared with abdominal sacrocolpopexy, with longer operative time, less blood loss, and shorter length of stay. Long-term data are needed to assess the durability of this new minimally invasive procedure. LEVEL OF EVIDENCE: II.
Matthews CA. Surgical techniques: Robot-assisted laparoscopic colposacropexy with the da Vinci® surgical system. Journal of Robotic Surgery 2009;3(1):35-9.
Colposacropexy is the gold-standard operation for repair of apical vaginal support defects. While it is feasible to perform this operation using conventional laparoscopic techniques, a limited number of surgeons have mastered the advanced minimally invasive skills that are required. Introduction of the da Vinci® robotic system with instruments that have improved dexterity and precision and a camera system with three-dimensional imaging presents an opportunity for more surgeons treating women with pelvic organ prolapse to perform the procedure laparoscopically. This paper will outline a technique that is exactly modeled after the open procedure for completion of a robotic-assisted colposacropexy using the da Vinci® surgical system. © 2009 Springer-Verlag London Ltd.
Di Marco DS, Chow GK, Gettman MT, Elliott DS. Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. Urology . 2004 Feb; 63(2): 373-376. Abstract .
Elliott DS, Chow GK, Gettman M. Current status of robotics in female urology and gynecology. World J Urol. 2006 Jun;24(2):188-92. Epub 2006 Mar 24. Abstract .
Elliott DS, Krambeck AE, Chow GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol. 2006 Aug;176(2):655-9. 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.