Hartman KE, Ma C, Lamvu GM, et al. Quality of life and sexual function after hysterectomy in women with preoperative pain and depression. Obstet Gynecol 2004;104:701–709.
Javier F. Magrina
Robotic surgery is a form of facilitated laparoscopy that utilizes robotic technology to enhance the performance of the operation by placing a computerized interface between patient and surgeon.
Two of the most important differences between conventional laparoscopic instruments and robotic instruments are articulation and intuitive movements.
The robotic system offers advantages for the surgeon, but it is particularly useful in four circumstances: obese patients, long surgeries, and operations requiring extensive suturing or high precision.
High precision and absence of tremor are useful for retroperitoneal lymphadenectomy, adhesiolysis, parametrial ureteral dissection, and accurate suturing, in such procedures as ureteral anastomosis or reimplantation, and genitourinary fistula repair.
Applications of robotic technology include simple hysterectomy, myomectomy, appendectomy (in conjunction with other procedures), adnexectomy, excision of severe endometriosis, tubal anastomosis, and rectovaginal or vesicovaginal fistulas, especially those in the upper vagina.
Studies show the feasibility of robotics for the treatment of patients with cervical, endometrial, tubal, and ovarian cancer, with apparent similar or better perioperative outcomes compared to laparoscopy and with improved outcomes compared to laparotomy.
Robotic technology as applied to laparoscopy utilizes robotic technology to facilitate the performance of the operation by placing a computerized interface between patient and surgeon. Although originally designed for cardiovascular surgery and approved for that use by the U.S. Food and Drug Administration (FDA) in 2003, it has found applications in urology and gynecology, and more recently in otolaryngology and colorectal surgery.
There are studies showing that the use of robotic technology for the performance of preset laboratory exercises results in faster performance times, increased accuracy, enhanced dexterity, easier and faster suturing, and a lower number of errors when compared to conventional laparoscopic instrumentation (1–4). The physical stress for medical students learning robotics is significantly less than what they encounter when learning the same tasks by laparoscopy (5). The technological advantages of robotics can facilitate learning surgical techniques when compared to acquiring similar skills in laparoscopy, as demonstrated by a shorter learning curve for robotic surgery. There is a ﬂattening of the operating time after 20 to 50 robotic hysterectomies, while for laparoscopically assisted vaginal hysterectomy (LAVH) a similar facility with the requisite skills does not occur until after 80 procedures (6–9). In gynecologic oncology, a ﬂattening of the operating time was noted after 20 procedures for endometrial cancer when using the robotic technology (10).
Robotic Technology and Differences with Laparoscopy
There is only one robotic system available, brand-named Da Vinci (Intuitive Inc, Sunnyvale, CA), which received FDA approval for the performance of hysterectomy in 2005. A second generation of the device, the Da Vinci S, was released in 2006, and the third generation of the Da Vinci robotic system, the SI model, was released in 2009 and incorporates a resident teaching console. A robotic system is composed primarily of a robotic column, which holds the robotic arms (Fig. 25.1) and a surgeon’s console (Fig. 25.2). The robotic arms that hold the robotic instruments (Fig. 25.3) are fastened to the robotic trocars (Fig. 25.4). Commonly used robotic instruments for gynecologic surgeries are shown in Figure 25.5A-F.
Figure 25.1 Robotic column with robotic arms.
Figure 25.2 Robotic console with hand controls and foot switches.