Comparison between single‐site and multiport robot‐assisted hysterectomy in obese patients with endometrial cancer: An Italian multi‐institutional study

Corrado, Giacomo; Mereu, Liliana; Bogliolo, Stefano; Cela, Vito; Gardella, Barbara; Sperduti, Isabella; Certelli, Camilla; Pellegrini, Alice; Posar, Giulia; Zampa, Ashanti; Tateo, Saverio; Gadducci, Angiolo; Spinillo, Arsenio; Vizza, Enrico

doi:10.1002/rcs.2066

Cited by 8 publications

(15 citation statements)

References 22 publications

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“…These factors may have limited the adoption of MAS for common gynecological procedures such as hysterectomy and sacrocolpopexy 9,10 . Robot‐assisted surgery offers improved dexterity, precision, and three‐dimensional visualization 11,12 and can extend MAS feasibility for patients with complex pathologies or higher body mass indices (BMIs) 13 …”

Section: Introductionmentioning

confidence: 99%

“…9,10 Robot-assisted surgery offers improved dexterity, precision, and three-dimensional visualization 11,12 and can extend MAS feasibility for patients with complex pathologies or higher body mass indices (BMIs). 13 Versius (CMR Surgical, Cambridge, UK), a next-generation robotic surgical system, aims to improve patient outcomes and enduser experience. [14][15][16][17] The device comprises practical-sized mobile bedside units to provide maximum flexibility in the operating room (OR).…”

Section: Introductionmentioning

confidence: 99%

“… 9 , 10 Robot‐assisted surgery offers improved dexterity, precision, and three‐dimensional visualization 11 , 12 and can extend MAS feasibility for patients with complex pathologies or higher body mass indices (BMIs). 13 …”

Section: Introductionmentioning

confidence: 99%

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Early evaluation of a next‐generation surgical system in robot‐assisted total laparoscopic hysterectomy: A prospective clinical cohort study

Borse

Godbole

Kelkar

et al. 2022

Acta Obstet Gynecol Scand

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Introduction This study aimed to demonstrate the safe and effective use of the Versius surgical system (CMR Surgical, Cambridge, UK) in robot‐assisted total laparoscopic hysterectomy. This surgical robot was developed iteratively with input from surgeons to improve surgical outcomes and end‐user experience. We report data from the gynecology cohort of an early clinical trial designed in broad alignment with IDEAL‐D (Idea, Development, Exploration, Assessment, Long‐term follow‐up – Devices) stage 2b (Exploration). Material and methods The study is registered in the Indian clinical trials register (CTRI/2019/02/017872). Adult women requiring total hysterectomy who provided informed consent and met the eligibility criteria underwent procedures at one of three hospitals in India. Five surgeons performed robot‐assisted total laparoscopic hysterectomies using the device from March 2019 to September 2020. The primary endpoint was rate of unplanned conversion to conventional laparoscopic or open surgery. Adverse events were adjudicated by an independent clinical events committee using endoscope video recordings and clinical notes. Results In total, 144 women underwent surgery (median age: 44 years [range: 28–78]; median body mass index 25.8 kg/m2 [range: 14.3–47.8]). The rate of unplanned conversion to conventional laparoscopy was 2/144 (1.4%); neither conversion was device related. No surgery was converted to open. In total, 13 adverse events occurred among seven (4.9%) patients, comprising seven serious adverse events and six adverse events. One serious adverse event was deemed device‐related. Two patients were readmitted to hospital within 30 days; both made a full recovery. No patients died within 90 days of surgery. Conclusions The device provides a safe and effective option for total laparoscopic hysterectomy; these findings support its continued implementation in larger patient cohorts and expansion in other major minimal access indications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early evaluation of a next‐generation surgical system in robot‐assisted total laparoscopic hysterectomy: A prospective clinical cohort study

Borse

Godbole

Kelkar

et al. 2022

Acta Obstet Gynecol Scand

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“…By shortening the learning curve, these advantages may enable more surgeons to perform complex MAS procedures, and could extend the feasibility of MAS to a greater body of surgeons [2]. In addition, robot-assisted MAS could be feasible in a wider range of patients, such as those with a higher body mass index (BMI) [14,15].…”

Section: Introductionmentioning

confidence: 99%

Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

et al. 2020

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Robot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. In particular, the provision of stable magnified three-dimensional vision, tremor filtering, motion scaling, and articulated instruments with robot-assisted surgery has the potential to enable more surgeons to perform more complex surgery compared with conventional laparoscopy. The aim of this study was to evaluate the utility of a new robot-assisted surgical system (Versius, CMR Surgical, Cambridge, UK) for gynecologic procedures in a preclinical setting. Cadaveric sessions were conducted to evaluate the ability of the system to complete all surgical steps required for a robot-assisted total laparoscopy hysterectomy. A live animal (porcine) model was used to assess the system in performing oviduct removal as a surrogate for robot-assisted total laparoscopy hysterectomy. Procedures were performed by experienced gynecologic surgeons, supported by a surgical team. The precise surgical steps conducted to conclude that the procedures could be fully completed were systematically recorded, as well as instruments used and endoscope angle. In total, six gynecologic procedures were performed in cadavers by four surgeons; 16/17 procedures were completed successfully. Positioning of the ports and bedside units reflected the surgeons' preferred laparoscopic setup and enabled good surgical access and reach, as exemplified by the high procedure completion rate. Oviduct removal procedures performed in pigs were all completed successfully by a single surgeon. This preclinical study of a new robot-assisted surgical system for gynecologic procedures demonstrated the safety and effectiveness of the system in cadaver and porcine models. Further studies are required to assess its clinical utility.

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“…Conversion rate, the intraoperative transition from a robotic procedure to an alternative surgical approach, was reported by three studies [28,29,31]. Two studies reported that no patients required a conversion in both single-port and multiport approaches [28,31].…”

Section: Conversion Ratementioning

confidence: 99%

Surgical Outcomes Following Robotic Single-Site Versus Multiport Hysterectomy for Treatment of Endometrial Cancer: A Systematic Review and Meta-Analysis

Schnittka¹,

Lanpher²,

Cushing-murray³

et al. 2023

Cureus

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Robotic single-site hysterectomy (RSSH) has emerged as a novel surgical approach for the treatment of endometrial cancer and atypical endometrial hyperplasia (AEH). Current research regarding the benefits of RSSH compared to robotic multiport hysterectomy (RMPH) for these indications has been inconclusive. Our team sought to compare surgical outcomes between these two approaches of robotic hysterectomy via systematic review and meta-analysis to ensure optimal surgical practices. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist guided our review. MEDLINE, Clinicaltrials.gov, and Cochrane Library were searched, yielding 59 results. Articles were filtered by title and abstract and then reviewed in full for inclusion and exclusion criteria. Inclusion criteria required that (1) studies compared outcomes for RSSH and RMPH, (2) hysterectomy was indicated for endometrial cancer or hyperplasia with atypia, and (3) studies were available in English. Excluded studies (1) compared single-site and multiport laparoscopic approaches, (2) compared robotic approaches to laparoscopic or abdominal (open) techniques, and (3) employed hysterectomy for benign conditions. Publication bias was assessed using the Egger Regression Correlation analysis. Four studies complied with the selection criteria, comprising 138 patients in the RSSH group and 259 in the RMPH group. Similar outcomes were noted across all measures, including conversion rate (relative risk [RR] = 1.84 and confidence interval [CI] = 0.99-3.43), blood loss (Cohen's d = 1.05 and Z = 18.62), operating time (Cohen's d = 0.29 and Z = 4.38), and length of hospital stay (Cohen's d = 1.06 and Z = 3.86). Publication bias was deemed minimal as indicated by Egger regression values of less than 0.05. These findings suggest that either a surgical approach or AEH with the proper standard of care can provide patients with endometrial cancer.

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Comparison between single‐site and multiport robot‐assisted hysterectomy in obese patients with endometrial cancer: An Italian multi‐institutional study

Cited by 8 publications

References 22 publications

Early evaluation of a next‐generation surgical system in robot‐assisted total laparoscopic hysterectomy: A prospective clinical cohort study

Early evaluation of a next‐generation surgical system in robot‐assisted total laparoscopic hysterectomy: A prospective clinical cohort study

Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

Surgical Outcomes Following Robotic Single-Site Versus Multiport Hysterectomy for Treatment of Endometrial Cancer: A Systematic Review and Meta-Analysis

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