Robot-assisted surgery in gynecology

Youn-Jee Chung; Mee-Ran Kim

doi:10.5124/jkma.2019.62.4.209

J Korean Med Assoc > Volume 62(4); 2019 > Article

Chung and Kim: Robot-assisted surgery in gynecology

Continuing Education Column

Journal of the Korean Medical Association 2019; 62(4): 209-215.

Published online: April 11, 2019

DOI: http://dx.doi.org/10.5124/jkma.2019.62.4.209

Robot-assisted surgery in gynecology

Youn-Jee Chung, MD^1,²

, Mee-Ran Kim, MD^1,²

¹Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

²Seoul St. Mary's Fibroid Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Corresponding author: Mee-Ran Kim. mrkim@catholic.ac.kr

Received January 31, 2019 Accepted April 03, 2019

Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The development of robotic technology has facilitated the application of minimally invasive techniques for complex gynecologic surgery. Robot-assisted gynecologic surgery has grown exponentially since receiving Food and Drug Administration approval for use in gynecologic surgery in 2005. Robotic surgery has several major advantages, including three-dimensional visual magnification, articulation beyond normal manipulation, and the filtering of the operator's hand tremors. Therefore, robotic surgery is suitable for microsurgery, and it could be an alternative option for laparotomy. Robotic surgery has advantages, especially for suture-intensive operations such as myomectomy. Patients who underwent robot-assisted laparoscopic myomectomy had significantly decreased estimated blood loss, complication rates, and length of hospital stay. The advantages of robotic surgery help to overcome the limitations of laparoscopy, especially for complicated procedures in deep infiltrating endometriosis. Although extensive radical operations for deep infiltrating endometriosis of the bowel and urinary tract, such as segmental resections of the bladder, ureters, and bowel, were performed by laparotomy in the past, they are now performed more easily and more effectively using robotic techniques. In a recent systematic review and meta-analysis, robotic and laparoscopic sacrocolpopexy resulted in similar clinical outcomes, but robotic surgery was associated with a longer operation time and higher costs. Robotic and conventional laparoscopic hysterectomy show equivalent surgical and clinical outcomes. Compared to laparotomy, robotic gynecologic cancer surgery results in improved clinical outcomes and comparable oncologic outcomes. If robotic surgery is tailored in terms of patient selection, surgeon ability, and equipment availability, it could be a feasible option for highly advanced minimally invasive surgery.

Robotic surgical procedures; Minimally invasive surgical procedures; Uterine myomectomy; Hysterectomy; Trachelectomy

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