The Use of Robotic-Assisted Surgery for Gynecologic Malignancies and Complex
Medical Director, Gynecologic Oncology, The Lacks Cancer Center,
Saint Maryfs Health Care, Grand Rapids, Michigan, USA
The da Vinci® Robotic Surgical System was first introduced in 1999 by Intuitive Surgical for use in minimally invasive surgery. Similar to standard laparoscopy, the da Vinci uses a series of small incisions to introduce a camera and operative instruments. Unlike standard laparoscopy, robotic technology allows minimally-invasive surgery to be performed for many complex surgical procedures that are not amenable to standard laparoscopic techniques. The da Vincifs high-definition 3-D vision system and wristed instruments recreate the dexterity and precision of open surgery, bypassing the instrument limitations of standard laparoscopy
One of the major applications of robotic-assisted surgery is for gynecologic procedures. It is particularly useful for the management of gynecologic malignancies and for complex gynecologic procedures such as endometriosis and fibroid surgery, many of which would require an open procedure to be completed. We describe the use of robotic-assisted surgery on the gynecologic oncology service at our institution from 4/2007 until the present. Nearly 1000 cases have been successfully completed by one surgeon, including hysterectomy, oophorectomy, pelvic and para-aortic lymph node dissection, radical pelvic surgery for cervical and vaginal cancer, and ovarian cancer debulking. Its greatest use has been for endometrial cancer, for which we have used the da Vinci exclusively for all endometrial cancer operations since the first case in 2007. Our experience has shown less operative morbidity, including less blood loss, infections, and wound problems. Similar to many U.S. institutions, robotic-assisted surgery has become the standard of care for the surgical management of patients on the gynecologic oncology service at our institution.