Operative procedures supported with robotics systems and available endoscope procedures in operative gynecology

Abstract

Minimally invasive surgery revolutionized operative procedures in the last 20 years. Much of the progress in minimally invasive surgery can be attributed to the development of robot-based systems. The most apparent changes are found in laparoscopy procedures. Procedures in which only small skin incisions are made have revolutionized operating theaters. The learning curve, although long in itself, allows for the development of procedures with reduced perioperative risk (i.e., bleeding, pain) or shorter postoperative period. Convalescence after endoscopy procedures is significantly shorter compared with classic laparotomy. However, certain limitations apply to laparoscopy. Apart from the long learning curve, movements executed with long and rigid tools cannot strictly translate the precision of an operator's hand. The body position of the surgeon is often forced by the reach of the endoscope instrument. It is related to a significant physical load of personnel, especially during long operating procedures. For this reason, some therapeutic procedures are still executed using the laparotomy approach. Modern endoscopic proceduresModern operative medicine cannot exist without endoscopic solutions. Both indications and the perioperative period have an important effect on the selection of laparoscopic operating procedures for patients. Operative gynecology takes advantage of a broad range of possibilities offered by laparoscopy [1]. Indications allow the use of the described technique in cases of changes in adnexa and in the body of the uterus, infertility, repair of pelvic floor disorders, and in procedures performed for oncological reasons. In some cases, even a minimal increase in procedure duration leads to additional blood loss or postoperative pain. Compared with laparotomy, the postoperative course using endoscopic procedures allows faster recovery and restoration to a regular lifestyle. In addition, if maintaining a "youthful" appearance is one of the considerations, the aesthetic aspects of using endoscopy procedures cannot be over estimated either.The following is a review of the operative procedures that can be performed with specialized endoscopic equipments: -Hysterectomy -Laparoscopic supracervical hysterectomy -Laparoscopically assisted vaginal hysterectomy -Laparoscopic total hysterectomy -Laparoscopically assisted total vaginal hysterec tomy -Laparoscopically assisted radical vaginal hysterectomyIn laparoscopically assisted vaginal hysterectomy and laparoscopically assisted radical vaginal hysterectomy, a vaginal manipulator is used to expose the uterus. It is only allowed in non-oncological cases.-Ablation or enucleation of uterine myomas -Ablation or enucleation of ovarian cysts