Gynecologic robotic laparoendoscopic single-site surgery: prospective analysis of feasibility, safety, and technique

Stacey A. Scheib, Amanda N. Fader, Fader AN
American journal of obstetrics and gynecology · 2014 · vol. 212(2) , pp. 179.e1–179.e8 · doi:10.1016/j.ajog.2014.07.057 · PMID:25088863 · W2006022197
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This prospective study analyzed the feasibility, safety, and surgical technique of gynecologic robotic laparoendoscopic single-site surgery.

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Abstract

OBJECTIVE: Multiple reports suggest that laparoendoscopic single-site surgery is technically feasible, safe, and effective in treating a variety of gynecological disease processes. The study purpose was to assess the feasibility and safety of a novel robotic single-site platform (R-LESS) for the surgical treatment of benign and malignant gynecological conditions. STUDY DESIGN: A single-institution, prospective analysis of 40 women treated with R-LESS on the gynecology and gynecological oncology services from June 2013 through March 2014. Women undergoing hysterectomy or adnexal surgery for either a benign or malignant gynecological condition were offered robotic single-site surgery during the study period of June 1, 2013, through April 1, 2014. Patients underwent surgery through a single 2.5-3.0 cm umbilical incision with a multichannel port and utilizing the da Vinci robotic single-site platform. Two surgeons with extensive laparoendoscopic single-site experience participated. RESULTS: Forty patients had R-LESS performed. Procedures included total laparoscopic hysterectomy, laparoscopic supracervical hysterectomy, salpingo-oophorectomy, ovarian cystectomy, excision of endometriosis, and a combined case of total laparoscopic hysterectomy and cholecystectomy. Median age and body mass index were 42 years and 28.2 kg/m(2), respectively. Median operating time, defined as the interval between incision start to closure, was 134 minutes (range, 84-311 minutes). Median vaginal cuff closure was 21 minutes (range, 9-77 minutes). Overall, there appeared to be a linear relationship between vaginal cuff closure time, console time, and operating time with number of cases performed. Procedures were successfully performed via R-LESS in 92.5% of cases; 2 cases required 1 additional port and there was 1 conversion to traditional multiport robotic surgery. There was 1 major postoperative complication (2.5%) and 1 readmission (2.5%). After a median follow-up period of 230 days (range, 61-256), there have been no postoperative hernias diagnosed. CONCLUSION: We present one of the first series of robotic laparoendoscopic single-site surgery for the treatment of various gynecological conditions. When performed by experienced minimally invasive surgeons, R-LESS is feasible and safe in select patients. Further studies are needed to better define the ideal gynecological procedures to perform using robotic single-site surgery and to assess the benefits and costs of R-LESS compared with multiport robotic and conventional laparoscopic approaches.

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Condition tags

endometriosis

MeSH descriptors

Endoscopy Gynecologic Surgical Procedures Laparoscopy Postoperative Complications Robotic Surgical Procedures Adult Adult Aged Aged Endometriosis Endometriosis Endometriosis Endoscopy Endoscopy Feasibility Studies Feasibility Studies Female Female Gynecologic Surgical Procedures Gynecologic Surgical Procedures

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