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Robotics in Gynecology

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Minimally Invasive Gynecology

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Abstract

Since the Food and Drug Administration (FDA) approval of the da Vinci Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) in April 2005, robotic-assisted surgery has become popular among both gynecologic surgeons and their patients. Despite its widespread use, the role of robotic surgery in benign gynecology remains controversial. The available literature on this topic is lacking in quality, and the studies that have been conducted are mostly inconclusive. Nonetheless, a few key attributes of robotic surgery that are difficult to refute, even for the robot “nonsupporters,” include the fact that robotic surgery offers:

  1. (a)

    A more ergonomic option for the surgeon when compared to conventional laparoscopy

  2. (b)

    A less morbid surgical alternative when compared to abdominal surgery

  3. (c)

    The option of minimally invasive surgery for a broader patient pool

For the purpose of this chapter, we will focus on the role of robotic surgery in benign gynecology. We will review the most recent and relevant peer-reviewed literature as we discuss the use of robotic laparoscopy for the surgical management of deeply infiltrating endometriosis, myomectomy, hysterectomy, and sacrocolpopexy/cervicopexy. We will include a brief description of our general setup for robotic procedures, and in our discussions of each of these topics, we will provide a basic case card and a corresponding video, if available.

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Change history

  • 02 September 2023

    A correction has been published.

References

  1. Litynski GS. Endoscopic surgery: the history, the pioneers. World J Surg. 1999;23(8):745–53.

    CAS  PubMed  Google Scholar 

  2. William W. Hurd, MD, MSc, MPH; Chief Editor: Michel E. Rivlin, MD. Gynecologic laparoscopy. Medscape. Available at http://emedicine.medscape.com/article/265201-overview#showall. Accessed 16 Apr 2016.

  3. Rosero EB, Kho KA, Joshi GP, Giesecke M, Schaffer JI. Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease. Obstet Gynecol Surv. 2014;69(1):18–9.

    Google Scholar 

  4. Falcone T, Goldberg JM, Margossian H, Stevens L. Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study. Fertil Steril. 2000;73:1040–2.

    CAS  PubMed  Google Scholar 

  5. Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C Jr. Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc. 2002;16:1271–3.

    CAS  PubMed  Google Scholar 

  6. Soto E, Lo Y, Friedman K, Soto C, Nezhat F, Chuang L, Gretz H. Total laparoscopic hysterectomy versus da Vinci robotic hysterectomy: is using the robot beneficial? J Gynecol Oncol. 2011;22(4):253–9.

    PubMed  PubMed Central  Google Scholar 

  7. Kumari S, Rupa B, Sanjay M, Sinha R. Robotic surgery in gynecology. J Minim Access Surg. 2015;11(1):50–9.

    PubMed  PubMed Central  Google Scholar 

  8. Advincula AP, Song A. The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol. 2007;19(4):331–6.

    PubMed  Google Scholar 

  9. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin N Am. 1997;24(2):235–58.

    CAS  Google Scholar 

  10. Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril. 1990;53(6):978–83.

    CAS  PubMed  Google Scholar 

  11. Fauconnier A, Chapron C, Dubuisson J-B, Vieira M, Dousset B, Bréart G. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril. 2002;78(4):719–26.

    PubMed  Google Scholar 

  12. Fauconnier A, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update. 2005;11(6):595–606.

    CAS  PubMed  Google Scholar 

  13. Hsu AL, Khachikyan I, Stratton P. Invasive and non-invasive methods for the diagnosis of endometriosis. Clin Obstet Gynecol. 2010;53(2):413–9. https://doi.org/10.1097/GRF.0b013e3181db7ce8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012;98(3):–591, 598.

    Google Scholar 

  15. G S, Ieda N, Rosati R, Vitobello D. Robotic surgery for deep endometriosis: a paradigm shift. Int J Med Robot. 2014;10(2):140–6.

    Google Scholar 

  16. Pellegrino A, Damiani GR, Trio C, Faccioli P, Croce P, Tagliabue F, Dainese E. Robotic shaving technique in 25 patients affected by deep infiltrating endometriosis of the rectovaginal space. J Minim Invasive Gynecol. 2015;22(7):1287–92.

    PubMed  Google Scholar 

  17. Neme RM, Schraibman V, Okazaki S, Maccapani G, Chen WJ, Domit CD, Kaufmann OG, Advincula AP. Deep infiltrating colorectal endometriosis treated with robotic-assisted rectosigmoidectomy. JSLS. 2013;17(2):227–34.

    PubMed  PubMed Central  Google Scholar 

  18. Nezhat FR, Sirota I. Perioperative outcomes of robotic assisted laparoscopic surgery versus conventional laparoscopy surgery for advanced-stage endometriosis. JSLS. 2014;18(4)

    Google Scholar 

  19. Gargiulo AR. Computer-assisted reproductive surgery: why it matters to reproductive endocrinology and infertility subspecialists. Fertil Steril. 2014;102(4):911–21.

    PubMed  Google Scholar 

  20. Management of uterine fibroids. Summary, Evidence Report/ Technology Assessment: Number 34. AHRQ Publication No. 01-E051, 2001. Agency for Healthcare Research and Quality, Rockville, MD, USA.

    Google Scholar 

  21. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188:100–7.

    PubMed  Google Scholar 

  22. Stewart EA. Uterine fibroids. Lancet. 2001;357:293–8.

    CAS  PubMed  Google Scholar 

  23. Nash K, Feinglass J, Zei C, Lu G, Mengesha B, Lewicky-Gaupp C, Lin A. Robotic-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparative analysis of surgical outcomes and costs. Arch Gynecol Obstet. 2012;285:435–40.

    PubMed  Google Scholar 

  24. Herrmann A, De Wilde RL. Laparoscopic myomectomy – the gold standard. Gynecol Minim Invasive Ther. 2014;3(2):31–8.

    Google Scholar 

  25. Holzer A, Jirecek ST, Illievich UM, Huber J, Wenzl RJ. Laparoscopic versus open myomectomy: a double-blind study to evaluate postoperative pain. Anesth Analg. 2006;102(5):1480–4.

    CAS  PubMed  Google Scholar 

  26. Mais V, Ajossa S, Guerriero S, et al. Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol. 1996;174:654–8.

    CAS  PubMed  Google Scholar 

  27. Jin C, Hu Y, Chen XC, et al. Laparoscopic versus open myomectomy – a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2009;145:14–21.

    PubMed  Google Scholar 

  28. Pluchino N, Litta P, Freschi L, et al. Comparison of the initial surgical experience with robotic and laparoscopic myomectomy. Int J Med Robot. 2014;10:208–12.

    PubMed  Google Scholar 

  29. Parker WH, Iacampo K, Long T. Uterine rupture after laparoscopic removal of a pedunculated myoma. J Minim Invasive Gynecol. 2007;14(3):362–4.

    PubMed  Google Scholar 

  30. Advincula AP, Song A, Burke W, et al. Preliminary experience with robot-assisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 2004;11:511–8.

    PubMed  Google Scholar 

  31. Advincula AP, Xu X, Goudeau S, Ransom SB. Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs. J Minim Invasive Gynecol. 2007;14:698–705.

    PubMed  Google Scholar 

  32. Ascher-Walsh CJ, Capes TL. Robot-assisted laparoscopic myomectomy is an improvement over laparotomy in women with a limited number of myomas. J Minim Invasive Gynecol. 2010;17:306–10.

    PubMed  Google Scholar 

  33. Hanafi MM, Hsu Y-S, Fomo AN. Comparative study between robotic laparoscopic myomectomy and abdominal myomectomy and factors affecting short-term surgical outcomes. J Reprod Med Endokrinol. 2010;7:258.

    Google Scholar 

  34. Mansour FW, Kives S, Urbach DR, Lefebvre G. Robotically assisted laparoscopic myomectomy: a Canadian experience. J Obstet Gynaecol Can. 2012;34:353–8.

    PubMed  Google Scholar 

  35. Sangha R, Eisenstein D, George A, Munkarah A, Wegienka G. Comparison of surgical outcomes for robotic assisted laparoscopic myomectomy compared to abdominal myomectomy. J Minim Invasive Gynecol. 2010;17(Suppl):S108.

    Google Scholar 

  36. Pundir J, Pundir V, Walavalkar R, Omanwa K, Lancaster G, Kayani S. Robotic-assisted laparoscopic vs abdominal and laparoscopic myomectomy: systematic review and meta-analysis. J Minim Invasive Gynecol. 2013;20(3):335–45.

    PubMed  Google Scholar 

  37. Barakat EE, Bedaiwy MA, Zimberg S, Nutter B, Nosseir M, Falcone T. Robotic-assisted, laparoscopic, and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol. 2011;117:256–65.

    PubMed  Google Scholar 

  38. Gargiulo AR, Nezhat C. Robot-assisted myomectomy: broadening the Laparoscopists’s armamentarium. In: Tinelli AA, Malvasi A, editors. Uterine myoma, myomectomy and minimally invasive treatments. Basel, Switzerland: Springer International Publishing; 2015. p. 193. https://doi.org/10.1007/978-3-319-10305-1_13.

    Chapter  Google Scholar 

  39. Cela V, Freschi L, Simi G, Tana R, Russo N, Artini PG, Pluchino N. Fertility and endocrine outcome after robot-assisted laparoscopic myomectomy (RALM). Gynecol Endocrinol. 2013;29(1):79–82.

    CAS  PubMed  Google Scholar 

  40. Kang SY, Jeung I-C, Chung Y-J, Kim H-K, Lee CR, Mansukhani TS, Kim M-R. Robot-assisted laparoscopic myomectomy for deep intramural myomas. Int J Med Robot. 2016. https://doi.org/10.1002/rcs.1742.

  41. Pitter MC, Srouji SS, Gargiulo AR, et al. Fertility and symptom relief following robot-assisted laparoscopic myomectomy. Obstet Gynecol Int. 2015; Article ID 967568, 9 pages. doi:https://doi.org/10.1155/2015/967568.

  42. Quaas AM, Einarsson JI, Srouji S, Gargiulo AR. Robotic myomectomy: a review of indications and techniques. Rev Obstet Gynecol. 2010;3(4):185–91.

    PubMed  PubMed Central  Google Scholar 

  43. Whiteman M, Hillis S, Jamieson D, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol. 2008;198(1):34.e1–7. https://doi.org/10.1016/j.ajog.2007.05.039.

    Article  PubMed  Google Scholar 

  44. Olsson JH, Ellstrom M, Hahlin M. A randomised prospective trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol. 1996;103:345–50.

    CAS  PubMed  Google Scholar 

  45. Garry R, Fountain J, Mason S, Napp V, Brown J, Hawe J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ. 2004. https://doi.org/10.1136/bmj.37984.623889.F6.

  46. Jacoby VL, Autry A, Jacobson G, Domush R, Nakagawa S, Jacoby A. Nationwide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches. Obstet Gynecol. 2009;114(5):1041–8.

    PubMed  PubMed Central  Google Scholar 

  47. Gobern JM, Rosemeyer CJ, Barter JF, Steren AJ. Comparison of robotic, laparoscopic, and abdominal myomectomy in a community hospital. JSLS. 2013;17(1):116–20. https://doi.org/10.4293/108680812X13517013317473.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Nieboer TE, Hendriks JCM, Bongers MY, Vierhout ME, Kluivers KB. Quality of life after laparoscopic and abdominal hysterectomy: a randomized controlled trial. Obstet Gynecol. 2012;119(1):85–91.

    PubMed  Google Scholar 

  49. American College of Obstetricians and Gynecologists. ACOG Committee Opinion no. 628: robotic surgery in gynecology. Obstet Gynecol. 2015;125:760–7.

    Google Scholar 

  50. American College of Obstetricians and Gynecologists. ACOG Committee Opinion no. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114:1156–8.

    Google Scholar 

  51. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol. 2011;18:1–3.

    Google Scholar 

  52. Scandola M, Grespan L, Vicentini M, Fiorini P. Robot-assisted laparoscopic hysterectomy vs traditional laparoscopic hysterectomy: five metaanalyses. J Minim Invasive Gynecol. 2011;18:705–15.

    PubMed  Google Scholar 

  53. Liu H, Lawrie TA, Lu D, Song H, Wang L, Shi G. Robot-assisted surgery in gynaecology. Cochrane Database Syst Rev. 2014;12:CD011422.

    Google Scholar 

  54. Gala RB, Margulies R, Steinberg A, et al. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol. 2014;21:353–61.

    PubMed  Google Scholar 

  55. Lönnerfors C, Reynisson P, Persson J. A randomized trial comparing vaginal and laparoscopic hysterectomy vs robot-assisted hysterectomy. J Minim Invasive Gynecol. 2015;22:78–86.

    PubMed  Google Scholar 

  56. Martínez-Maestre MA, Gambadauro P, González-Cejudo C, Torrejón R. Total laparoscopic hysterectomy with and without robotic assistance: a prospective controlled study. Surg Innov. 2014;21:250–5.

    PubMed  Google Scholar 

  57. Paraiso MF, Ridgeway B, Park AJ, et al. A randomized trial comparing conventional and robotically assisted total laparoscopic hysterectomy. Am J Obstet Gynecol. 2013;208:368.e1–7.

    PubMed  Google Scholar 

  58. Sarlos D, Kots L, Stevanovic N, von Felten S, Schär G. Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol. 2012;120:604–11.

    PubMed  Google Scholar 

  59. Albright BB, Witte T, Tofte AN, Chou J, Black JD, Desai VB, Erekson EA. Robotic versus laparoscopic hysterectomy for benign disease: a systematic review and meta-analysis of randomized trials. J Minim Invasive Gynecol. 2016;23(1):18–27.

    PubMed  Google Scholar 

  60. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    CAS  PubMed  Google Scholar 

  61. Fialkow MF, Newton KM, Lentz GM, Weiss NS. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):437–40.

    CAS  PubMed  Google Scholar 

  62. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol. 2009;114:1278–83.

    PubMed  Google Scholar 

  63. Lane FE. Modified technique of sacral colpopexy. Am J Obstet Gynecol. 1982;142:933.

    CAS  PubMed  Google Scholar 

  64. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013:CD004014.

    Google Scholar 

  65. Coolen AL, van Oudheusden AM, van Eijndhoven HW, et al. A comparison of complications between open abdominal sacrocolpopexy and laparoscopic sacrocolpopexy for the treatment of vault prolapse. Obstet Gynecol Int. 2013;2013:528636.

    PubMed  PubMed Central  Google Scholar 

  66. Hsiao KC, Latchamsetty K, Govier FE, Kozlowski P, Kobashi KC. Comparison of laparoscopic and abdominal sacrocolpopexy for the treatment of vaginal vault prolapse. J Endourol. 2007;21:926–30.

    PubMed  Google Scholar 

  67. Freeman RM, Pantazis K, Thomson A, et al. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J. 2013;24(3):377–84.

    CAS  PubMed  Google Scholar 

  68. Costantini E, Mearini L, Lazzeri M, Bini V, Nunzi E, di Biase M, Porena M. Laparoscopic versus abdominal sacrocolpopexy: a randomized controlled trial. J Urol. 2016;196(1):159–65.

    PubMed  Google Scholar 

  69. Yohannes P, Rotariua P, Pintoa P, Smitha A, Leea B. Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology. 2002;60(1):39–45.

    PubMed  Google Scholar 

  70. Geller EJ, Siddiqui NY, Wu JM, et al. Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol. 2008;112(6):1201–6.

    PubMed  Google Scholar 

  71. De Gouveia M, Claydon LS, Whitlow B, Artahona MAD. Laparoscopic versus open sacrocolpopexy for treatment of prolapse of the apical segment of the vagina: a systematic review and meta-analysis. Int Urogynecol J. 2016;27(1):3–17.

    Google Scholar 

  72. Elliott CS, Hsieh MH, Sokol ER, Comiter CV, Payne CK, Chen B. Robot-assisted versus open sacrocolpopexy: a cost-minimization analysis. J Urol. 2012;187:638–43.

    PubMed  Google Scholar 

  73. Hoyte L, Rabbanifard R, Mezzich J, Bassaly R, Downes K. Cost analysis of open versus robotic-assisted sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012;18:335–9.

    PubMed  Google Scholar 

  74. Paraiso MF, Jelovsek JE, Frick A, Chen CC, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118(5):1005–13.

    PubMed  Google Scholar 

  75. Anger JT, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman A, Brubaker L, Bresee C, Kenton K. Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2014;123(1):5–12.

    PubMed  PubMed Central  Google Scholar 

  76. Ke P, Zhang Y, Wanga Y, Wangd Y, Xua H. A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy. Int J Gynecol Obstet. 2016;132(3):284–91.

    Google Scholar 

  77. Callewaert G, Bosteels J, Housmans S, Verguts J, Van Cleynenbreugel B, Van der Aa F, De Ridder D, Vergote I, Deprest J. Laparoscopic versus robotic-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review. Gynecol Surg. 2016;13(2):115–23.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, Columbia University Medical Center/New York-Prebyterian Hospital, New York, NY, USA

    Arnold P. Advincula M.D. & Obianuju Sandra Madueke-Laveaux M.D.

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  1. Arnold P. Advincula M.D.
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Correspondence to Arnold P. Advincula M.D. .

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Editors and Affiliations

  1. CliniOnco, Porto Alegre, Rio Grande do Sul, Brazil

    Geraldo Gastal Gomes-da-Silveira

  2. UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil

    Gustavo Py Gomes da Silveira

  3. Universidade Federal do Rio Grande do Sul (UFRGS) and Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil

    Suzana Arenhart Pessini

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Advincula, A.P., Madueke-Laveaux, O.S. (2018). Robotics in Gynecology. In: Gomes-da-Silveira, G.G., da Silveira, G.P.G., Pessini, S.A. (eds) Minimally Invasive Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-72592-5_3

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