Objective The aim of this research was to assess the role of robotics and its outcome in gynaecology both in benign and malignant cases in a single centre and provide a critical evaluation of possible advantages of robot assisted surgeries from surgeons’ point of view.
Design A single centre, retrospective observational study.
Population All women who underwent robotic gynaecological surgeries between 2015 and 2022.
Methods The Da Vinci Si™ robotic system was used for these surgeries performed by all surgeons at our quaternary care centre, and data were acquired retrospectively through electronic medical records. Descriptive statistical analysis of data was done. Main outcome measures included operative time, estimated blood loss, hospital stay, complications and conversion rates in all cases. Age was analysed as a demographic data.
Outcome A total of 211 robotic cases were performed including 172 hysterectomies, 20 myomectomies and 19 cases for other gynaecological indications. The mean operating time or hysterectomy and myomectomy was 113 and 129 min, respectively, and haemoglobin drop was 1.34 and 1.2 g/dl, respectively. No conversions to laparotomy were observed in either of the groups. The surgeries for 19 benign gynaecological conditions included ovarian cystectomy, cesarean scar repair and chronic cornual ectopic.
Conclusion Robotic surgical system helps accomplish several procedures with exceptional laparoscopic skills. Robotic surgery is safe in all types of gynaecological procedures and is a promising alternative for comprehensive gynaecologic surgical care.
Keywords : Hysterectomy · Laparoscopy · Robotic · Myomectomy · Cystectomy
The use of robotics in surgery was hypothesised as far back as 1967 and has evolved continuously with the development of first fully functional multipurpose surgical robot over 30 years ago, to the currently available US FDA approved multipurpose robotic surgery system—Intuitive Surgical Inc.’s Da Vinci™ Surgical System, which is found in operating rooms across the globe.
The introduction of robots for assistance in gynaecological surgery, with particular reference to the Da Vinci™ Surgical System, has been a ground breaking discovery, which has changed the way gynaecologic procedures are carried out [1, 2]. The Stanford Research Institute developed Da Vinci™ system initially so that surgeons could operate remotely on wounded soldiers via the means of telesurgery [1, 2]. However, today the scenario is that of the surgeon operating on the patient being in the same room but on an ergonomically designed console, viewing the surgical field in a 3D vision and manipulating the wristed laparoscopic instruments through the masters and foot pedal [2]. The US FDA approved the system for use in gynecology in 2005 based on the data and reports of safety and efficacy in studies conducted for cases of myomectomy and hysterectomy at the University of Michigan [1, 2]. Currently, applications in gynecology include but not limited to hysterectomy, myomectomy, oophorectomy, and ovarian cystectomy, resection of endometriosis, sacrocolpopexy and lymphadenectomy. The use of robotic assistance in laparoscopy is gaining popularity due its ability to overcome difficulties of conventional laparoscopy while allowing patients to benefit from minimally invasive surgery [2, 3].
The purpose of this article is to critically assess the role of robotics and its outcome in gynaecology both in benign and malignant cases in a single quaternary care centre.
Declarations
Conflict of interest The authors declare that they have no conflict
of interest.
Ethical Approval The study was performed following the principles of the Declaration of Helsinki and its modifications. Data were obtained from medical records and de-identifed, with no direct participation of patients.
Informed Consent This was a retrospective observational study. The Institutional Research Ethics Committee has confirmed that no ethical approval is required and patient consent is waived.
