Robotic-Assisted Surgery for the Community Gynecologist

Abstract

The American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists confirm advantages of conventional minimally invasive surgery over laparotomy for benign gynecological procedures; however, adoption remains low for the general gynecologist. A systematic search for gynecology publications was performed using Medline and Scopus. Available data on adoption rates and perioperative outcomes for hysterectomy, myomectomy, sacrocolpopexy, and endometriosis were reviewed. Robotic assistance may provide an improved rate of minimally invasive surgery adoption with equivalent perioperative outcomes to that of conventional techniques. Accessibility and cost remain controversial. Formal training programs are being created to address these issues.

Comparison of Robotic, Laparoscopic and Abdominal Myomectomy in a Community Hospital

“…18,20 Technical advantages of robotic-assisted laparoscopic surgery may help overcome these challenges and perhaps improve the adoption of the laparoscopic technique. 8,11 These advantages include 3-dimensional visualization, instrument articulation, improved dexterity, and the elimination of tremor and counterintuitive movements. 21,22 Specifically, these advantages offer the community-based gynecologist greater facility with which to suture and surgically dissect laparoscopically.…”

“…Despite advances in laparoscopic technique, as well as the advantages of laparoscopic myomectomy reported over 30 y, most gynecologic procedures are still performed through abdominal incisions. 8,19 The technical skill required for excision of myoma and lack of surgeon experience are considered significant limiting factors to the wide acceptance of this technique. 18,20 Technical advantages of robotic-assisted laparoscopic surgery may help overcome these challenges and perhaps improve the adoption of the laparoscopic technique.…”

“…8,11 While these characteristics have been demonstrated in university-based teaching hospitals and medical centers, this is the first comparison of abdominal, laparoscopic and RALM in a community hospital. 10 This study demonstrated reduced blood loss and shorter hospital stay consistent with previously published reports.…”

“…4,5 Comparison of outcomes for laparoscopic and robotic-assisted laparoscopic myomectomy (RALM) has demonstrated comparable clinical outcomes for blood loss, hospital stay, and complications despite longer robotic operative times. 6,7 The feasibility of the adoption of robotic-assisted surgery by the community gynecologist has been discussed by Payne et al 8 The authors concluded that the length of stay and decrease in blood loss seen with robotic-assisted surgery "hold true not only for academic centers but also in community settings involving Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD, USA (Drs Gobern, Rosemeyer); Women's Health Specialist, Holy Cross Hospital, Silver Spring, MD, USA (Drs Barter, Steren).…”

Abdominal ve Laparoskopik Myomektomilerin Postoperatif Komplikasyonlar ve Fertilite Açısından Değerlendirilmesi

“…laparoskopik tekniğin avantajları bildirilmesine rağmen birçok jinekolojik operasyon hala abdominal yolla yapılmaktadır (8).…”