Robotic surgery for gynecologic cancers: indications, techniques and controversies

Abstract

Minimally invasive surgery for gynecologic cancers is associated with fewer postoperative complications including less blood loss and quicker recovery time compared to traditional laparotomy. The robotic platform has allowed patients access to minimally invasive surgery due to its increased utilization by gynecologic oncologists. Many surgeons have embraced the robotic platform due to its technological advances over traditional laparoscopy including high-definition 3D optics, wristed instrumentation, camera stability and improved ergonomics. While robotic surgery continues as a mainstay in the management of gynecologic cancers, it remains controversial in regards to its cost effectiveness and more recently, its long-term impact on clinical and oncologic outcomes. A strong component of the justification of this surgical platform is based on extrapolated data from traditional laparoscopy despite limited prospective randomized trials for roboticassisted surgery. In this review, we highlight the use of robotic surgery in the management of gynecologic cancers in special populations: fertility sparing patients, the morbidly obese, the elderly, and patients with a favorable response to neoadjuvant chemotherapy.

Robot-assisted surgery for early uterine corpus cancer: assessing the learning curve

“…Robot-assisted surgery is very important for gynecologic malignancies because, like prostate cancer surgery, it requires delicate deep-field techniques and good visualization. Moreover, robot-assisted surgery is also indicated for benign uterine myoma, and in the United States, the gynecological department comprised the largest number of robot-assisted surgery [3,4]. Some papers have reported that the learning curve for robotassisted surgery requires 20 to 30 cases for significant improvement in many departments, including gynecology and urology [5][6][7].…”

“…Obesity is one of the factors complicating cancer surgery due to the obstruction of surgical view by adipose tissues, especially for open surgeries. The implementation of robotassisted surgery was found to overcome this issue in obese patients because it does not require as much force to operate forceps or secure visual fields [4,5]. Another study reported that in obese patients, robot-assisted surgery was associated with a significantly reduced operating time and blood loss, increased number of lymph nodes removed and decreased hospital stay compared with open surgery [4].…”

“…The implementation of robotassisted surgery was found to overcome this issue in obese patients because it does not require as much force to operate forceps or secure visual fields [4,5]. Another study reported that in obese patients, robot-assisted surgery was associated with a significantly reduced operating time and blood loss, increased number of lymph nodes removed and decreased hospital stay compared with open surgery [4]. Peacock et al [13] reported that in obese patients with lower rectal cancer, robot-assisted surgery was also beneficial in reducing blood loss and the incidence of several complications compared with open surgery.…”

“Iavazzo score”, a preoperative score to predict duration of robotic‐assisted gynaecological surgeries

“…More In the current literature, there is no reliable scoring system that can predict duration or difficulty of open abdominal, laparoscopic or robotic-assisted laparoscopic procedures. 8,9 For this reason, in our plans is to organise a multicentre retrospective or prospective trial to clarify the possible predictive value of our proposed Iavazzo score in all gynaecological procedures performed robotically and compared them with analysis in open and laparoscopic approach.…”

Building a Personalized Medicine Infrastructure for Gynecological Oncology Patients in a High-Volume Hospital

“…In the challenge of preserving healthy tissues next to the tumor, radiation oncologists can irradiate target cells while preserving surrounding areas to avoid long-term toxicity [24]. Roboticassisted surgery is likely to help surgeons manage patients with high BMI with a minimally invasive approach (meaning shorter hospitalization and less pain) [25]. Personalized treatments can also be integrated with alternative approaches (e.g., palliative and supportive care) to provide the relief of cancer-related symptoms in the end-of-life setting.…”