The current state and the future of robotic surgery in female pelvic medicine and reconstructive surgery

Rachael D Sussman, Benoit Peyronnet, Benjamin M. Brucker
Turkish journal of urology · 2019 · doi:10.5152/tud.2019.19068 · PMID:31509506 · PMC6739090
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This review highlights the current applications and future potential of robotic surgery for pelvic organ prolapse, pelvic pain, urologic reconstruction, and stress urinary incontinence in female pelvic medicine.

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This narrative review assessed current applications and future directions of robotic surgery in female pelvic medicine and reconstructive surgery, highlighting the role of robots’ visualization and suturing capabilities for deep pelvic procedures. It reports that robotic techniques have been used for pelvic organ prolapse (including sacrocolpopexy, sacrohysteropexy, and uterosacral ligament plication) and for various causes of female pelvic pain, listing fibroids, endometriosis, and nerve entrapment; it also describes robotic repair of iatrogenic injuries with reported avoidance of conversion to open surgery. The paper notes that more data are needed, particularly studies evaluating robotic outcomes versus open and laparoscopic approaches, and it acknowledges the increased cost of robotic surgery. Relevance to endometriosis: the review explicitly includes endometriosis among the etiologies of female pelvic pain treated with robotic surgery, though its main focus is the overall landscape of robotic surgery in female pelvic medicine and reconstructive surgery.

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Abstract

In this article, we review the current uses and future directions of robotic surgery in the field of female pelvic medicine and reconstructive surgery. Pelvic surgery is ideal for the use of surgical robots, which provide improved visualization and ease of suturing deep within the pelvis. Robots have been successfully used for the treatment of pelvic organ prolapse, in procedures such as sacrocolpopexy, sacrohysteropexy, and uterosacral ligament plication. Surgeons have used the robotic successfully to treat various etiologies of female pelvic pain including fibroids, endometriosis, and nerve entrapment. Robotic repair of iatrogenic injury has been described with excellent outcomes and avoidance of conversion to open surgery in the event of an injury caused using the robotic platform. While more data is needed on this topic, there has been increasing interest in using the robot for urologic reconstruction including repair of vesico-vaginal fistula, cystectomy, augmentation cystoplasty, and continent and non-continent diversions. Recently the use of the robot has been described in the treatment of stress urinary incontinence in females, with robotic placement of an artificial urinary sphincter. While robotic surgery is associated with increased cost, the outcomes of robotic surgery in female urology are promising. More studies that properly evaluate the benefits of robotic surgery as compared to open and laparoscopic approaches are needed.
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Urology Research and Practice (Oct 2019) The current state and the future of robotic surgery in female pelvic medicine and reconstructive surgery Abstract In this article, we review the current uses and future directions of robotic surgery in the field of female pelvic medicine and reconstructive surgery. Pelvic surgery is ideal for the use of surgical robots, which provide improved visualization and ease of suturing deep within the pelvis. Robots have been successfully used for the treatment of pelvic organ prolapse, in procedures such as sacrocolpopexy, sacrohysteropexy, and uterosacral ligament plication. Surgeons have used the robotic successfully to treat various etiologies of female pelvic pain including fibroids, endometriosis, and nerve entrapment. Robotic repair of iatrogenic injury has been described with excellent outcomes and avoidance of conversion to open surgery in the event of an injury caused using the robotic platform. While more data is needed on this topic, there has been increasing interest in using the robot for urologic reconstruction including repair of vesico-vaginal fistula, cystectomy, augmentation cystoplasty, and continent and non-continent diversions. Recently the use of the robot has been described in the treatment of stress urinary incontinence in females, with robotic placement of an artificial urinary sphincter. While robotic surgery is associated with increased cost, the outcomes of robotic surgery in female urology are promising. More studies that properly evaluate the benefits of robotic surgery as compared to open and laparoscopic approaches are needed. Cite this article as: Sussman RD, Peyronnet B, Brucker BM. The current state and the future of robotic surgery in female pelvic medicine and reconstructive surgery. Turk J Urol 2019; 45(5): 331-9. Keywords

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