Robot-Assisted Surgery in Gynecology

Abstract

Robotic-assisted surgery offers a stable high-resolution 3-dimensional perspective, wrist-like mobility of therobotic arms with motion scaling and tremor control. These functions compensate the disadvantages of conventional laparoscopic surgery and improve ergonomics with a shortened learning curve. In field of gynecology, robotassisted surgery was initially applied to laparoscopic tubal anastomosis at Cleveland Clinic in 1998. The procedures have expanded to cystectomy, oophorectomy, simple and radical hysterectomy, myomectomy, pelvic andparaaortic lymphadenectomy, removal of deep infiltrating endometriosis, and the like. In Japan the first robotassisted hysterectomy was performed at Tokyo Medical University in 2009. In 2018, robot-assisted laparoscopichysterectomy for benign disease and early-stage endometrial cancer was covered by insurance. In 2020, robotic sacrocolpopexy was added to insurance coverage. In our department, we started robot-assisted laparoscopichysterectomy with bilateral salpingo-oophorectomy for early-stage endometrial cancer in 2019. This operation isperformed in compliance with the guidelines of the Japanese Society of Obstetrics and Gynecology, and all patients need to be registered in the National Clinical Database (NCD). Although the da Vinci surgical system fromIntuitive Surgical has long dominated the field of robot-assisted surgery, with the expiration of the core patentsof Intuitive Surgical, multiple robot-assisted surgical systems with costly and functional effectiveness have beenintroduced to market. The robot-assisted surgical system is also applied to vaginal natural orifice transluminalendoscopic surgery.