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

      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/m2, 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.

      Key words

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      References

        • Nieboer T.E.
        • Johnson N.
        • Lethaby A.
        • et al.
        Surgical approach to hysterectomy for benign gynaecological disease.
        Cochrane Database Syst Rev. 2009; : CD003677
        • Yuen P.M.
        • Yu K.M.
        • Yip S.K.
        • Lau W.C.
        • Rogers M.S.
        • Chang A.
        A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses.
        Am J Obstet Gynecol. 1997; 177: 109-114
        • Fanfani F.
        • Fagotti A.
        • Ercoli A.
        • et al.
        A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses.
        Hum Reprod. 2004; 19: 2367-2371
        • Deckardt R.
        • Saks M.
        • Graeff H.
        Comparison of minimally invasive surgery and laparotomy in the treatment of adnexal masses.
        J Am Assoc Gynecol Laparosc. 1994; 1: 333-338
        • Medeiros L.R.
        • Rosa D.D.
        • Bozzetti M.C.
        • et al.
        Laparoscopy versus laparotomy for benign ovarian tumour.
        Cochrane Database Syst Rev. 2009; : CD004751
        • Galaal K.
        • Bryant A.
        • Fisher A.D.
        • Al-Khaduri M.
        • Kew F.
        • Lopes A.D.
        Laparoscopy versus laparotomy for the management of early stage endometrial cancer.
        Cochrane Database Syst Rev. 2012; : CD006655
        • Shin J.H.
        • Howard F.M.
        Abdominal wall nerve injury during laparoscopic gynecologic surgery: incidence, risk factors, and treatment outcomes.
        J Am Assoc Gynecol Laparosc. 2012; 19: 448-453
        • Fader A.N.
        • Cohen S.
        • Escobar P.F.
        • Gunderson C.
        Laparoendoscopic single-site surgery in gynecology.
        Curr Opin Obstet Gynecol. 2010; 22: 331-338
        • Uppal S.
        • Frumovitz M.
        • Escobar P.
        • Ramirez P.T.
        Laparoscopic single-site surgery in gynecology: review of literature and available technology.
        J Minim Invas Gynecol. 2010; 18: 12-23
        • Murji A.
        • Patel V.I.
        • Leyland N.
        • Choi M.
        Single-incision laparoscopy in gynecologic surgery: a systematic review and meta-analysis.
        Obstet Gynecol. 2013; 121: 819-828
        • Fader A.N.
        • Escobar P.F.
        Laparoendoscopic single-site surgery (LESS) in gynecologic oncology: technique and initial report.
        Gynecol Oncol. 2009; 114: 157-161
        • Fanfani F.
        • Rossitto C.
        • Gagliardi M.L.
        • et al.
        Total laparoendoscopic single site surgery (LESS) hysterectomy in low risk early endometrial cancer: a pilot study.
        Surg Endosc. 2012; 26: 41-46
        • Fagotti A.
        • Boruta D.
        • Scambia G.
        • Fanfani F.
        • Paglia A.
        • Escobar P.F.
        First 100 early endometrial cancer cases treated with laparoendoscopic single-site surgery: a multicentric retrospective study.
        Am J Obstet Gynecol. 2012; : 353.e1-353.e5
        • Chen Y.J.
        • Wang P.H.
        • Ocampo E.J.
        • Twu N.F.
        • Yen M.S.
        • Chao K.C.
        Single-port compared with conventional laparoscopic-assisted vaginal hysterectomy: a randomized controlled trial.
        Obstet Gyncol. 2011; 117: 906-912
        • Song T.
        • Kim M.L.
        • Jung Y.W.
        • Yoon B.S.
        • Joo W.D.
        • Seong S.J.
        Laparoendoscopic single-site versus conventional laparoscopic gynecologic surgery: a metaanalysis of randomized controlled trials.
        Am J Obstet Gynecol. 2013; 209: 317.e1-317.e9
        • Boggess J.F.
        • Gehrig P.A.
        • Cantrell L.
        • et al.
        A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy.
        Am J Obstet Gynecol. 2008; 199: 360.e1-360.e9
        • Spinoglio G.
        • Lenti L.M.
        • Maglione V.
        • et al.
        Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience.
        Surg Endosc. 2012; 26: 1648-1655
        • Escobar P.F.
        • Fader A.N.
        • Paraiso M.F.
        • Kaouk J.H.
        • Falcone T.
        Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique.
        J Minim Invasive Gynecol. 2009; 16: 589-591
        • Scheib S.A.
        Robotic assisted single site access surgical endoscopy (RA-SSASE): initial report and technique.
        J Minim Invasive Gynecol. 2010; 17: S33
        • Scheib S.A.
        • Curlin H.
        Single incision robotic assisted total laparoscopic hysterectomy.
        J Minim Invasive Gynecol. 2011; 18: S178
        • Fagotti A.
        • Bottoni C.
        • Giuseppe V.
        • et al.
        Postoperative pain after conventional laparoscopy and laparoendoscopic single-site surgery (LESS) for benign adnexal disease: a randomized trial.
        Fertil Steril. 2011; 96: 255-259
        • Hoyer-Sorensen C.
        • Vistad I.
        • Ballard K.
        Is single-port laparoscopy for benign adnexal disease less painful than conventional laparoscopy? A single-center randomized controlled trial.
        Fertil Steril. 2012; 98: 973-979
        • Li M.
        • Han Y.
        • Feng Y.C.
        Single-port laparoscopic hysterectomy versus conventional laparoscopic hysterectomy: a prospective randomized trial.
        J Int Med Res. 2012; 40: 701-708
        • Gunderson C.C.
        • Knight J.
        • Ritter C.
        • Escobar P.F.
        • Ibeanu O.
        • Fader A.N.
        The risk of umbilical hernia and other complications with laparoendoscopic single-site surgery.
        J Minim Invasive Gynecol. 2012; 19: 40-45
        • Nam E.J.
        • Kim S.W.
        • Lee M.
        • et al.
        Robotic single-port transumbilical total hysterectomy: a pilot study.
        J Gynecol Oncol. 2011; 22: 120-126
        • Cela V.
        • Freschi L.
        • Simi G.
        • et al.
        Robotic single-site hysterectomy: feasibility, learning curve and surgical outcome.
        Surg Endosc. 2013; 27: 2638-2643
        • Escobar P.F.
        • Kebria M.
        • Falcone T.
        Evaluation of a novel single-port robotic platform in the cadaver model for the performance of various procedures in gynecologic oncology.
        Gynecol Oncol. 2011; 120: 380-384
        • Vizza E.
        • Corrado G.
        • Mancini E.
        • et al.
        Robotic single-site hysterectomy in low risk endometrial cancer: a pilot study.
        Ann Surg Oncol. 2013; 20: 2759-2764
        • Fagotti A.
        • Corrado G.
        • Fanfani F.
        • et al.
        Robotic single-site hysterectomy (RSS-H) vs. laparoendoscopic single-site hysterectomy (LESS-H) in early endometrial cancer: a double institution case-control study.
        Gynecol Oncol. 2013; 130: 219-223
        • Sendag F.
        • Akdemir A.
        • Zeybek B.
        • Ozdemir A.
        • Gunusen I.
        • Oztekin M.K.
        Single-site robotic total hysterectomy: standardization of technique and surgical outcomes.
        J Minim Invasive Gynecol. 2014; 21: 689-694