Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

Sinha, Rooma; Rupa, Bana; Reddy, Mamatha M.

doi:10.1007/s11701-022-01470-1

Cited by 6 publications

(2 citation statements)

References 22 publications

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“…All three cases were performed by an experienced laparoscopic surgeon, who underwent a prior 3-day cadaver lab a full training program of 50 hours of a dry lab (simulator), and three prior human cases of adnexal surgery. These ndings supporting the hypothesis of a simple learning curve of the Versius -especially if compared to traditional laparoscopy -are seemingly consistent with previous literature [19,20]. The loss of tactile feedback is seemingly replaced by the enhanced 3D visualization of the robotic system, which allows magni cation of deep spaces and cavities otherwise less accessible.…”

Section: Discussionsupporting

confidence: 89%

Robotic excision of parametrial endometriosis with the new Versius robotic system: a preliminary case series.

Gaia,

Afonina,

Felline

et al. 2023

Preprint

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Purpose: Endometriosis affects 10% of the female population in reproductive age. Although a greater awareness of the condition and constant progress in understanding its natural history, its treatment remain challenging. When it comes to surgical intervention, the minimally invasive, laparoscopic, or robotic approach is the gold standard. While offering better visualization and refinement of movements, the robotic system is burdened by often unaffordable costs. Since the Da Vinci patent expired, new platforms have entered this scene, trying to preserve the advantages of robotics, while cutting costs. To date, there are no deep infiltrating endometriosis cases reported in literature afforded with the new Versius surgical system. Materials and methods: We considered prospectively 3 patients undergoing robotic surgery for parametrial endometriosis with the versius system, in our tertiary referral multiplatform robotic center. The surgical technique was described step by step. Demographics, intra-operative robotic events and peri-operative outcomes were collected. Results: A total of 3 procedures were performed. The median BMI was 18.52 kg/m 2, [16.33-20.96]. The median age was 41 years [36-51]. Median docking time was 51 minutes [37-60], median console time 180 [136-223] minutes. Pneumoperitoneum was maintained at 9 mmHg. A single high priority collision occurred. Blood loss was negligible. There were no peri-operative complications nor conversions. Conclusions: Versius appeared to be a safe and feasible option for deep infiltrating endometriosis surgery. Our experience suggests operative room configuration and port placement to better perform these challenging procedures. These suggestions may enhance the mini-invasiveness while beating costs and making robotics worldwide approachable.

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Section: Discussionsupporting

confidence: 89%

Robotic excision of parametrial endometriosis with the new Versius robotic system: a preliminary case series.

Gaia,

Afonina,

Felline

et al. 2023

Preprint

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show abstract

“…We believe that the less time taken in suturing when robot is being used is responsible for this result. Patients in the RM group had significantly less blood loss (115.43±79.43 vs. 340.98±453.9 mL, P≤0.0001) and requirement of blood transfusion (93.97% vs. 81.97%, P=0.031) when compared to LM group [20]. Lim et al [9] also reported significantly fewer patients in the robotic-assisted cohort required intra-operative blood trans-fusions compared with patients in the abdominal, vaginal, and laparoscopic cohorts.…”

Section: Discussionmentioning

confidence: 94%

Single centre experience in India for benign gynecological robotic surgery with da Vinci Si system: A real world data analysis of one decade

Sinha¹,

Rupa²,

Reddy³

2023

Gyne Robot Surg

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Objective: To analyse real time data over a decade of robotic surgery for benign Gynecological conditions using the da Vinci Si system.Methods: This is a retrospective analysis of prospectively collected data of da Vinci Si robotic surgery between August 2012 and July 2021 at single medical centre by a single surgeon.Results: Of the total 452 cases, the procedures were broadly categorised into myomectomy (RM-204), hysterectomy (RH-150), endometriosis excision (RE-80). The mean age of 46.12±6.77 and the mean BMI 28.89±5.02 kg/m2 in RH group was higher in RH group when compared to RM and RE groups. The mean docking time over 10 years was 10.59 minutes and mean console time was 96.35±47.77 minutes and both were significantly lower in the last 5 years when compared to first 5 years. 49.9% patients did not require intravenous analgesics beyond 24 hours and only 7.2% needed beyond 48 hours. 44.7% had less than 24 hours of hospital stay and 1.1% stayed beyond 48 hours. The mean hemoglobin drop was 1.109±0.7531 g%, significantly higher in RM group. The mean specimen weight in RM group was 323.8 g (200–1,372 g) and 84 cases had multiple leiomyomas. The commonest indication of robotic surgery was fibroid uterus.Conclusion: Robotic surgery for benign gynecologic surgery feasible and safe. It has equivalent outcomes when compared to laparoscopic surgery and superior when compared with laparotomy. Using robots to reduce open and repeat surgery for injury corrections could translate to reductions in the over-all economic burden of treatment.

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Robotic‐assisted laparoscopic versus abdominal and laparoscopic myomectomy: A systematic review and meta‐analysis

Chen,

Ma,

Yang

et al. 2024

Intl J Gynecology & Obste

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BackgroundMyomectomy is the preferred treatment for women with uterine fibroids and fertility requirements. There are three modalities are used in clinical practice for myomectomy: abdominal myomectomy (AM), laparoscopic myomectomy (LM), and robot‐assisted laparoscopic myomectomy (RLM).ObjectivesTo compare the perioperative and postoperative outcomes of RLM, AM, and LM.Search StrategyWe searched PubMed, Web of Science, Embase, and Clinical Trials for relevant literature published between January 2000 and January 2023.Selection CriteriaWe included all studies reporting peri‐ and postoperative outcomes of myomectomy in patients with uterine myomas. Surgical treatments were classified as RLM, LM, or AM.Data Collection and AnalysisTwo or more authors selected studies independently, assessed risk of bias, and extracted data. We derived mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the patient characteristics and myoma characteristics. We used the I2 statistic to quantify heterogeneity and the random‐effects model for meta‐analysis when appropriate. We used the funnel plot to assess the publication bias.Main ResultsA total of 32 studies with 6357 patients were included, of which 1982 women had undergone RLM. The operating time was significantly longer (MD = 43.58, 95% confidence interval [CI]: 25.22–61.93, P < 0.001), and the incidence of cesarean section after myomectomy was significantly lower (OR = 0.27, 95% CI: 0.10–0.78, P = 0.02) in RLM than in LM. Compared with AM, the operation time, blood loss, blood transfusion rate, complication rate, total cost, length of hospital stay, and pregnancy rate of patients with RLM were significantly different.ConclusionsThe safety and effectiveness of RLM are superior to those of AM but inferior to those of LM.

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Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy

Cited by 6 publications

References 22 publications

Robotic excision of parametrial endometriosis with the new Versius robotic system: a preliminary case series.

Robotic excision of parametrial endometriosis with the new Versius robotic system: a preliminary case series.

Single centre experience in India for benign gynecological robotic surgery with da Vinci Si system: A real world data analysis of one decade

Robotic‐assisted laparoscopic versus abdominal and laparoscopic myomectomy: A systematic review and meta‐analysis

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