Preliminary experience with robot-assisted laparoscopic staging of gynecologic malignancies

Abstract

Objective: To evaluate the feasibility of integrating robot-assisted technology in the performance of laparoscopic staging of gynecologic malignancies.

Methods: Seven patients underwent robot-assisted laparoscopic staging procedures for gynecologic cancers. Data were collected and analyzed as a retrospective case series analysis.

Results: We attempted 7 robot-assisted laparoscopic staging procedures with no conversions to laparotomy. The median lymph node count for lymphadenectomy was 15 (range, 4 to 29). Mean operating time was 257 minutes (range, 174 to 345). The average estimated blood loss was 50 mL. One patient developed sinusitis and required intravenous antibiotics. The median hospital stay was 2 days.

Conclusion: Robot-assisted laparoscopic staging is a feasible technique that may overcome the surgical limitations of conventional laparoscopy.

Figure 1.

Photograph of the da Vinci Robotic Surgical System. From left to right: surgeon's console, patient-side surgical cart, and InSite vision tower. Photo courtesy of Intuitive Surgical.

Figure 2.

Photograph of the da Vinci master controls showing translation of surgeon hand movement to the EndoWrist instruments attached to the robotic arms. Photo courtesy of Intuitive Surgical.

Figure 3.

RUMI uterine manipulator is used to manipulate the uterus during surgery, and the Koh colpotomy ring is used to provide an insulated backstop for the colpotomy incision. The vaginal pneumo-occluder balloon maintains the pneumoperitoneum once the colpotomy incision is made. (Cooper Surgical Inc., Trumbull, CT)

Figure 4.

Port Placement. (A) The 12-mm camera port was placed in the umbilicus or above, depending on the size of the uterus. (B) The 8-mm lateral ports for robotic instruments mount directly to the robotic arms and were placed 2 cm to 3 cm medial and superior to the anterior superior ileac spine with modification based on size of the uterus. (C) The assist port was placed between the camera port and the right lower quadrant port. This was typically a 12-mm port, used to facilitate introduction of suture and suction/irrigation instruments.

Figure 5.

Photographs of retroperitoneal dissection during right pelvic lymphadenectomy. In the left frame, EndoWrist DeBakey and monoploar hook instruments are used to dissect out the obturator nerve. In the right frame, an EndoWrist bipolar forceps is used to remove a node bundle from the external iliac vein.

Figure 6.

Photographs of the right pelvic lymphadenectomy. In the left frame, an EndoWrist DeBakey is elevating a node from the underlying ureter and internal iliac artery. In the right frame, the pelvic node dissection has been completed, showing the skeletonized external iliac artery (1) and vein (2), ischial periosteum (3), anterior division of the hypogastric artery (4), obturator nerve (5), genitofemoral nerve (6), and psoas muscle (7).