Robot-Assisted Surgery Requiring an Intraoperative Transition to Laparoscopic Surgery Due to an Emergency System Shutdown: A Case Report

BACKGROUND Robot-assisted hysterectomy (RASH) for benign uterine disease has been covered by insurance in Japan since 2018. Our department introduced RASH in December 2020, and the number of procedures has increased without major complications. Herein, we report a case in which robot-assisted surgery required intraoperative conversion to conventional laparoscopy because of an unexpected robotic system shutdown. CASE REPORT A 54-year-old multiparous woman presented with hypermenorrhea and anemia caused by uterine adenomyosis. After unsuccessful conservative treatment, definitive surgical management was planned. Following 6 months of gonadotropin-releasing hormone analog therapy, RASH was performed using the da Vinci X system. Four robotic ports and a single 5-mm assistant port were placed. Total operative time was 202 minutes, including 148 minutes of console time. After transvaginal uterine removal and vaginal cuff closure, the robotic system suddenly underwent an emergency shutdown during confirmation of hemostasis, making intracorporeal manipulation impossible. Although the manufacturer was contacted immediately and troubleshooting was attempted, the system could not be restored. Therefore, the operation was converted to conventional laparoscopic surgery using the same port placement, and the procedure was completed successfully. The postoperative course was uneventful, and the patient was discharged without complications. CONCLUSIONS Robot-assisted surgery is increasingly used in gynecology because of its minimally invasive advantages. However, surgeons should be prepared for unexpected events such as robotic system failure. Familiarity with laparoscopic surgical techniques enables safe continuation of surgery in such situations. This case highlights the importance of maintaining laparoscopic surgical skills to ensure the safe performance of robot-assisted procedures.