Robotic Radical Hysterectomy: Surgical Technique
Radical hysterectomy remains the preferred method of treatment for patients with early cervical cancer (FIGO stages IA2-IB1-IIA1). The incorporation of robotic technology in the USA and other countries changed the avenue from laparotomy to a minimally invasive approach, something that laparoscopic technology did not fully do. Some of the major advantages of robot-assisted over conventional laparoscopy are its superior visualization (3D versus 2D) imaging of the operative field), its mechanical improvements such as its seven degrees of freedom (similar to the human arm and hand, while rigid conventional instruments have four degrees of freedom), the stabilization of instruments within the surgical field (in conventional laparoscopy, small movements by the surgeon are amplified including hand tremor), and its improved ergonomics for the operating surgeon. The technique of robotic radical hysterectomy or robotic-assisted radical hysterectomy will be described in this chapter. The reader must be knowledgeable of the indications, limitations, and location of metastatic nodes to indicate or not a robotic approach and to determine whether preoperative chemoradiotherapy is needed. Whenever chemoirradiation is contemplated, the radical hysterectomy should be avoided due to the increased morbidity of using both treatment modalities. In these cases systematic pelvic and aortic lymphadenectomy is done to limit the irradiation field.
KeywordsCervical cancer Minimally invasive surgery Radical hysterectomy Robotic radical hysterectomy Nervesparing
Conflict of Interest
The authors have neither commercial, proprietary, nor financial interests in the products and companies described in this chapter.
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