Robot-assisted laparoscopic hysterectomy: technique and initial experience.

BACKGROUND Our study objective was to develop a technique for robot-assisted laparoscopic hysterectomy and to evaluate feasibility of the technology to address the technical limitations of conventional laparoscopy. METHODS The study design was a case series analysis in a university hospital. Sixteen consecutive patients underwent robot-assisted laparoscopic hysterectomy and were assessed for outcomes. Robot-assisted hysterectomy technique was refined and is described. RESULTS There were no conversions to laparotomy. The mean uterine weight was 131.5 g (range 30 to 327 g). Median operating time was 242 minutes (range 170 to 432). Average estimated blood loss was 96 mL (range 50 to 300 mL). One patient experienced a delayed thermal bowel injury, 2 developed postoperative infections, and 1 developed a vaginal cuff hematoma that was managed expectantly. The median length of hospital stay was 1.5 days. CONCLUSIONS Robot-assisted laparoscopic hysterectomy is a feasible and promising new technique that may overcome surgical limitations seen with conventional laparoscopy.

[1]  J. Mäkinen,et al.  Morbidity of 10 110 hysterectomies by type of approach. , 2001, Human reproduction.

[2]  A. Leminen Comparison between personal learning curves for abdominal and laparoscopic hysterectomy , 2000, Acta obstetricia et gynecologica Scandinavica.

[3]  Ashutosh Tewari,et al.  Surgical robotics and laparoscopic training drills. , 2004, Journal of endourology.

[4]  Z. Holub,et al.  Laparoscopic hysterectomy in obese women: a clinical prospective study. , 2001, European journal of obstetrics, gynecology, and reproductive biology.

[5]  C. Steiner,et al.  Hysterectomy Rates in the United States 1990–1997 , 2002, Obstetrics and gynecology.

[6]  G. Cucinella,et al.  Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. , 1999, Human Reproduction.

[7]  M. Diamond,et al.  Endoscopic Surgery for Gynecologists , 1998 .

[8]  J. Hulka,et al.  Textbook of laparoscopy , 1997 .

[9]  C. Chapron,et al.  Hysterectomy techniques used for benign pathologies: results of a French multicentre study. , 1999, Human reproduction.

[10]  S. L. Chen,et al.  Complications and recommended practices for electrosurgery in laparoscopy. , 2000, American journal of surgery.

[11]  T. Falcone,et al.  Robotic-assisted laparoscopic microsurgical tubal anastomosis: a human pilot study. , 2000, Fertility and sterility.

[12]  H. Peterson,et al.  Hysterectomy in the United States, 1988‐1990 , 1994, Obstetrics and gynecology.

[13]  D. Olive,et al.  The AAGL classification system for laparoscopic hysterectomy. , 2000, The Journal of the American Association of Gynecologic Laparoscopists.

[14]  B. Morrow,et al.  Hysterectomy surveillance--United States, 1980-1993. , 1997, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[15]  A. García-Ruiz,et al.  Full robotic assistance for laparoscopic tubal anastomosis: a case report. , 1999, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[16]  Mark Whittaker,et al.  The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy , 2004, BMJ : British Medical Journal.

[17]  Concepcion R. Diaz-Arrastia,et al.  Laparoscopic hysterectomy using a computer-enhanced surgical robot , 2002, Surgical Endoscopy And Other Interventional Techniques.

[18]  H. Helenius,et al.  One-year cohort of abdominal, vaginal, and laparoscopic hysterectomies: complications and subjective outcomes. , 1999, Journal of the American College of Surgeons.