Learning curve analysis of intracorporeal cuff suturing during robotic single-site total hysterectomy.

STUDY OBJECTIVE: To analyze the learning curve of intracorporeal cuff suturing during robotic single-site total hysterectomy. DESIGN: Retrospective study (Canadian Task Force classification II-1). SETTING: University hospital. PATIENTS: Twenty-four patients with benign indications for hysterectomy. INTERVENTIONS: Twenty-four patients who underwent robotic single-site total hysterectomy to treat benign indications were included in the study. Surgical procedures were performed by a single surgeon with extensive experience in laparoscopy, using the single-site platform of the da Vinci Surgical System. All vaginal cuffs were closed intracorporeally using semi-rigid single-site instruments. MEASUREMENTS AND MAIN RESULTS: An exponential learning curve technique was used to analyze the learning curve. The overall mean (SD) vaginal cuff closure time was 23.2 (7) minutes. Learning curve analysis revealed a decrease in vaginal closure time after 14 procedures. CONCLUSIONS: An experienced robotic surgeon requires approximately 14 procedures to achieve proficiency in intracorporeal cuff suturing during robotic single-site total hysterectomy. Novel instruments that create perfect triangulation are needed to overcome the current challenges of suturing and to shorten operative time.

Robotic single-incision transumbilical total hysterectomy using a single-site robotic platform: initial report and technique.

The benefits of laparoscopic surgery over open abdominal surgery have been well documented. Efforts continue for development of strategies that further reduce the size of abdominal incisions and the number of trocars used. Laparoendoscopic single-site surgery (LESS) is a promising approach that can further enhance cosmetic satisfaction and reduce the risks of laparoscopic surgery. Loss of triangulation, instrument crowding and clashing, poor visualization, and ergonomic problems are the most challenging issues associated with the use of LESS. The combination of LESS and the robotic system seems to be a promising choice to overcome the technical difficulties of LESS. The da Vinci Single-Site Surgical Platform is a novel semi-rigid robotic operating system. We present our initial clinical experience with robotic-assisted single-incision transumbilical total hysterectomy using the novel da Vinci Single-Site Surgical Platform.

Single-site robotic total hysterectomy: standardization of technique and surgical outcomes.

STUDY OBJECTIVES: To evaluate the safety and feasibility of robotic single-site total hysterectomy and to compare the outcomes of newly implemented robotic single-site bipolar and external vessel-sealing device. DESIGN: Retrospective study (Canadian Task Force classification II-1). SETTING: University hospital. PATIENTS: Twenty-four patients with benign indications for hysterectomy. INTERVENTIONS: All patients underwent robotic-assisted single-incision transumbilical total hysterectomy using the novel da Vinci Single-Site Platform. Vaginal cuff closures were performed intracorporeally using the same technique in all cases. MEASUREMENTS AND MAIN RESULTS: The median age of the patients was 49.5 years (range, 40-61), and body mass index was 28.5 (range, 21-34). Blood loss was 22.5 mL (range, 7-120 mL). Docking time was 5.5 minutes (range, 3-10 minutes), console time was 74.5 minutes (range, 60-160 minutes), vaginal cuff closure time was 25 minutes (range, 16-41 minutes), and total operative time was 98.5 minutes (range, 71-183 minutes). When 2 groups were created according to the energy devices used during the procedures, console time in the newly implemented bipolar group was shorter than in the external sealing device group (69.5 minutes vs. 77 minutes; p = .03); however, no differences were found for uterus removal time (50.5 minutes vs. 53.5 minutes; p = .13). Differences were observed in vaginal cuff closure time (18.5 minutes vs 23 minutes; p = .01). CONCLUSION: Robotic single-site total hysterectomy using a newly implemented bipolar grasping instrument and even with intracorporeal cuff closure is a safe and feasible procedure in appropriately selected patients.

A novel technique for laparoscopic removal of the fallopian tube after ectopic pregnancy via transabdominal or transumbilical port using homemade bag: A randomized trial.

BACKGROUND: The purpose of this study was to evaluate the feasibility and surgical outcome of a novel technique for laparoscopic removal of the fallopian tube using a homemade retrieval bag through a 10-mm transumbilical or 5-mm transabdominal port. MATERIALS AND METHODS: A total of 40 women with ruptured ectopic tubal pregnancy were randomized into a 10-mm transumbilical group (n = 20) or a 5-mm transabdominal group (n = 20) according to the port used for specimen removal. Fallopian tube removal was performed using a new method based on the use of a homemade surgical glove as a retrieval bag. RESULTS: There were no differences in the demographic characteristics between the two groups. The specimen retrieval time was significantly shorter in the transumbilical group than in the transabdominal group. Post-operative pain scores, assessed using a visual analog scale, were similar between the groups. No cases of rupture of the homemade retrieval bag were observed. CONCLUSION: The laparoscopic removal of the fallopian tube through the 10-mm umbilical port using a homemade retrieval bag is associated with shorter operative time than retrieval through a 5-mm abdominal port. The present results showed the feasibility and safety of our homemade retrieval bag and novel technique.

Uterine rupture in pregnancy after robotic myomectomy.

Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. A gravida 2 para 1 woman aged 40 years who was 33-34 weeks pregnant presented to our clinic with serious abdominal pain, nausea and vomiting that had begun 6 hours previously. Her past surgical history included a robotic myomectomy 2 years ago in our unit. Obstetric ultrasonography revealed a 33-week fetus without a heartbeat whereupon she underwent emergency laparotomy and we found a 4 cm rupture on the anterior wall of the uterus. Uterine rupture should always be kept in mind, especially in patients with history of uterine surgery.

Vaginal cuff dehiscence with bowel evisceration after robotic hysterectomy.

Vaginal cuff dehisence with bowel evisceration after hysterectomy is a very rare complication. However, the incidance of this complication appears to be increased with the widely used techniques of laparoscopic surgery especially with robotic hysterectomy. In this case report we aimed to evaluate the risk factors and treatment methods for this complication.