Journal of Robotic Surgery

Comparison of postoperative pain in robotic and laparoscopic myomectomy: a retrospective cohort study

Gynecologic surgery with minimally invasive method using robotic or laparoscopic techniques has gained popularity for reducing perioperative discomfort and length of hospital stay. However, the debate over postoperative pain superiority between traditional laparoscopy and robotic surgery persist. This study compared the postoperative pain of patients within 24 h of robotic (RM) and laparoscopic myomectomy (LM). This retrospective cohort study included 24 and 53 patients who underwent RM and LM, respectively, between January 2019 and July 2023. The primary outcomes were the postoperative pain levels of patients within 24 h and the use and dosage of postoperative analgesia. Additional perioperative analgesia, including long-acting non-steroidal anti-inflammatory drugs (Dynastat) and abdominal nerve block, was also recorded. The secondary outcomes were blood loss and hospitalization duration. The patient characteristics were similar between the groups. Factors that could potentially increase pain, such as the number of ports (p < 0.0001), additional procedures (p = 0.0195), operative time (p < 0.0001), number of myomas (p = 0.0057), and the largest myoma size (p = 0.0086), were significantly higher in the RM group than in the LM group. However, there were no significantly different in the postoperative visual analog scale pain scores, use and dosage of ketorolac and opioid, and use of Dynastat and nerve block between the groups. Hospitalization duration and intraoperative blood loss were similar between the groups. RM and LM offer comparable postoperative pain outcomes, emphasizing the importance of patient-specific factors in decision-making regarding myomectomy techniques.

Comparison of uterine myometrial thickness at the site of myomectomy scar after surgery using laparoscopic and laparotomy methods

Fibroids are the most common benign tumours of the uterus, often requiring surgery when symptomatic. This study aims to investigate the impact of surgery using two methods, laparoscopy and laparotomy, on the thickness and vascularity of the uterine myometrium at the site of myomectomy scar (comparing sonographic features at the surgical scar site, including thickness, vascularity, and the extent of fibrotic tissue, in both open and laparoscopic surgical approaches). In this clinical trial, 100 women with type 2-5 fibroids and clinical symptoms, seeking surgery et al. Zahra Hospital, were enrolled in two groups: laparoscopy and laparotomy. Inclusion criteria were a maximum fibroid size of 8 cm and, in the case of multiple fibroids, a maximum of three, with the largest being 8 cm. 6 months post-surgery, sonographic assessments of the myomectomy scar site were compared between both groups. Participants showed no significant differences in demographic and obstetric factors. The most common clinical symptom (87%) in both groups was abnormal uterine bleeding (AUB). The mean hospital stay duration was statistically significantly lower in the laparoscopy group at 1.64 (SD 0.56) compared to 1.89 (SD 0.58) in the laparotomy group (p = 0.028). Additionally, the decrease in haemoglobin levels was 0.89 (SD 0.92) and 1.87 (SD 2.24) units, respectively, which showed a statistically significant difference (p = 0.003). The duration of surgery was significantly shorter in the laparotomy group (p = 0.001). Abdominal pressure was not observed in the laparoscopy group, while 12% of the laparotomy group reported complaints (p = 0.013). Based on the results obtained in this study, it can be concluded that there was no difference between these two methods in terms of improving uterine thickness and associated complications. However, the decrease in haemoglobin levels and the length of hospital stay were lower in patients undergoing laparoscopy.

Feasibility of robotic radical hysterectomy (RRH) with a new robotic system. Experience at Galaxy Care Laparoscopy Institute

The main objective of this study was to assess in a series of 30 patients, the feasibility, oncological safety and efficacy of radical hysterectomy by a new robotic system. Prospective study design. Galaxy Care Laparoscopy Institute and Multispeciality Hospital. We performed Robotic Radical Hysterectomy in patients from August 2019 through February 2020. All the surgeries were performed by a single surgeon (Puntambekar S). Since August 2019, 30 patients with early cervical cancer/endometrial cancer were selected for radical hysterectomy. All patients were in good general condition with controlled medical comorbidities. The mean operative time was 104 min, with mean total lymph node yield of 24.7. The average blood loss was 60 ml and the hospital stay was 2.1 days, and majority of the patients were catheter free by 1 week. Two patients developed uretero-vaginal fistula on the 8th day of surgery. One was managed with Double J stenting and in the other we did laparoscopic ureteroneocystostomy. Our study has demonstrated the feasibility, safety and efficacy of RRH by the Versius robotic systems.

Economic evaluation of robot-assisted, conventional laparoscopic, and open myomectomy: a 10-year single-center retrospective study

Robotic-assisted laparoscopy has expanded the surgical options for myomectomy, but its economic impact compared with laparotomy and conventional laparoscopy remains debated. We conducted a retrospective single-center study of 314 patients who underwent myomectomy between 2009 and 2019: 207 laparotomy, 78 robotic-assisted laparoscopy, and 29 conventional laparoscopy. Patients in the laparotomy group presented with significantly larger fibroids (mean weight 449 g vs 175 g in the robotic group, p < 0.001). Robotic procedures were associated with longer operative times (155 vs 98 min for laparotomy, p < 0.001) but shorter hospital stays (3.7 vs 5.0 days for laparotomy, p < 0.001). The hemoglobin drop was lower in the robotic group (1.2 vs 2.5 g/dL, p < 0.001), and minor complications were less frequent (8% vs 25% after laparotomy). Compared with conventional laparoscopy, robotic surgery allowed resection of more complex interstitial fibroids, but at the expense of longer operating times (155 vs 100 min for laparoscopy, p < 0.001). The mean global cost per procedure was €6,818 for robotic myomectomy, higher than laparotomy (€5,347) and laparoscopy (€5,188). Robotic myomectomy provides clinical advantages over laparotomy but remains associated with substantially higher costs.

Surgical procedures and techniques in robot-assisted uterine artery-preserving radical trachelectomy

The aim of the study was to study robotic cervical radical trachelectomy, aimed at standardizing and optimizing surgical procedures, thereby facilitating the learning process. All surgical procedures were based on the anatomy of the embryonic compartments, which not only help prevent tumor spillage due to disruption of the embryonic compartments, but also maximize the avoidance of inadequate resection margins. Using robotics to perform radical trachelectomy, combined with the concept of membrane anatomy, not only enables a bloodless surgical process, but also streamlines and simplifies the procedure, making it more efficient and precise. Utilizing robotics for radical hysterectomy can lead to a more meticulous and refined outcome. Precise surgical techniques contribute to standardizing and optimizing surgical procedures, thereby facilitating the learning process.

Current analysis of the survival implications for minimally invasive surgery in the treatment of early-stage cervix cancer

Early-stage cervical cancer (ESCC) is managed with radical hysterectomy, a procedure that can be performed either via open surgery or minimally invasive surgery (MIS), the latter of which is accomplished via traditional laparoscopy or robotic-assisted surgery. Previously, MIS was routinely incorporated into the management of ESCC due to the approach's reduced operative morbidity and truncated hospital stay duration, but more recent clinical evidence has since impugned the efficacy of MIS because of the reportedly inferior disease-free survival and overall survival outcomes compared to open surgery. However, additional studies have documented equivalent outcomes among the various surgical modalities, suggesting further exploration of clinical factors as we endeavor to conclusively determine the standard of care for patients diagnosed with ESCC.

How does robotic surgery affect gynecology patient care?

AbstractThe aim of this review is to map the current research on the needs of gynecological patients treated with robotic surgery. Systematic Rapid Review. Pubmed, Web of Science, Google Scholar. Search was limited from the years 2017–2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Rapid review is a synthesis of information produced in a shorter time than systematic reviews, which allows clinical nurses to access evidence in the decision-making process. The methodological steps implemented were the following: (1) needs assessment and topic selection, (2) study development, (3) literature search, (4) screening and study selection, (5) data extraction, (6) risk-of-bias assessment and (7) knowledge synthesis. The search yielded 815 articles, 746 were excluded after screening the title and abstract, and 69 full-text syntheses were performed. Only 10 articles were included in the final analysis. This research evaluated the effects of robotic surgery on the patient under seven themes; operative time, length of stay, complications, estimated blood loss, pain, survivor, and conversion. Five studies were on endometrial cancer, one study on gynecologic cancer, two studies on hysterectomy, one study on patient safety, and one study on cervical cancer. The results show that robotic surgery can change the needs of patients by solving ongoing problems in gynecological patients. This requires a better understanding of robotic surgery procedures while facilitating nursing care over patient care.

Endo-cost: efficient economic model of adopting robotic versus laparoscopic gynecological surgery for endometrial cancer

Abstract This retrospective cost-analysis study evaluated and compared the economic and clinical outcomes of laparoscopic versus robotic surgery in the treatment of endometrial cancer at the University and Polytechnic La Fe Hospital in Valencia, Spain. The analysis included 153 patients who underwent surgery between January 2022 and December 2024. Robotic surgery resulted in a shorter average hospital stay (1.12 vs. 1.7 days; p  &lt; 0.05) compared to laparoscopy, but was associated with significantly higher costs in both consumables (€1985 vs. €1197; p  &lt; 0.001) and fixed amortization (€2000 vs. €140; p  &lt; 0.001) and total cost per procedure (€4698 vs. €7052 ± 816; p  &lt; 0.001). No significant differences were observed in surgical time or postoperative complications. A theoretical cost model based on the high procedural volume (three robotic surgeries per day, 7920 total over ten years) still showed laparoscopy to be more cost-effective overall (€4596 vs. €5431 per procedure; p  &lt; 0.001). However, robotic surgery could become economically competitive with a 15% reduction in equipment costs and a 30% decrease in consumable expenses, provided at least two procedures are performed daily. Ultimately, although laparoscopy remains more cost-efficient under typical conditions, robotic surgery offers potential economic viability under optimized circumstances, supporting its consideration as a sustainable option in high-volume centers managing endometrial cancer.

Robotic-assisted surgery for endometrial cancer: a comparison of surgical and oncologic outcomes in patients with low and high BMI at an Indian tertiary care center

AbstractThe robotic-assisted surgery for endometrial cancer (EC) is becoming increasingly important, owing to the superior surgical outcomes. However, efficacy data from India is limited, particularly for older women who are obese. We undertook this study to compare the surgical outcomes of robotic-assisted surgery among Indian EC patients with a BMI of &lt; 30 and ≥ 30 kg/m2. A retrospective chart review was conducted for the period of May 2016 to October 2020. Data on patient demographics, medical history, clinical characteristics, and perioperative outcomes were collected by a single senior surgeon, followed by statistical analysis. A total of 99 patients; 39 in the BMI group &lt; 30 and 60 in the BMI group ≥ 30 kg/m2 were included in the study. The mean age of the BMI groups &lt; 30 and ≥ 30 kg/m2 was 60.92 ± 10.43 and 58.90 ± 8.52 years respectively (P = 0.2944). The mean total operating time was slightly higher in the BMI group &lt; 30 kg/m2 (P = 0.8552) but the difference was not statistically significant. Similarly, the mean blood loss (P = 0.2041), length of hospital stays (P = 0.6564), early (P = 0.7758) and delayed complications (P = 0.1878) were less in the BMI group &lt; 30 kg/m2 but the difference was not statistically significant either. At a median follow-up of 22.3 months, the number of recurrences (5.13% vs 3.33%) and deaths (2.56% vs 1.67%) were more in BMI &lt; 30 kg/m2 group. Our study suggests that obese older women predisposed to multiple medical co-morbidities and surgical complications would especially benefit from robotic-assisted technology regardless of their BMI.

Comparison of laparoscopic vs. robotic sentinel lymph node mapping and biopsy in  endometrial cancer

Abstract We compare the success of sentinel lymph node (SLN) biopsy between standard laparoscopy and robotic-assisted laparoscopy (RAL) in patients with endometrial cancer. Patients with uterine epithelial tumour types undergoing staging surgery were identified from January 2019 to March 2023. Included patients underwent a total hysterectomy, bilateral salpingo-oophorectomy and attempted bilateral SLN biopsy with indigocyanine green (ICG) dye, utilising either standard laparoscopy or RAL. 298 patients met the inclusion criteria. 211 (70.8%) had standard laparoscopy and 87 (29.2%) underwent RAL. The RAL cohort had significantly higher median body mass index (BMI) compared to standard laparoscopy (37 vs. 28 kg/m 2 , p  &lt; 0.001). The overall rate of successful bilateral SLN biopsy was 66.8% ( n  = 199), and at least one hemi-pelvis was successfully biopsied in 87.3% ( n  = 260) of patients. There was no significant difference in bilateral SLN biopsy success between RAL and standard laparoscopy (60.9% vs 69.2%, p  = 0.17). RAL was not predictive of bilateral SLN biopsy success in multivariate analysis (OR 1.10, p  = 0.76). There was no difference in SLN biopsy location, number of nodes identified, or empty-packet dissections between the surgical approaches. Increasing age (OR 0.96, p  = 0.002) and BMI (OR 0.94, p  &lt; 0.001) were significantly associated with reduced bilateral SLN biopsy success. Between the learning and experienced periods of the study, the bilateral SLN biopsy success rate improved significantly for RAL (40.6 vs. 72.7%, p  = 0.03), which was not found with standard laparoscopy. The decision to perform RAL should consider multiple factors including surgeon experience. Future research should be directed towards prospective, randomised and BMI-matched cohorts.

Pioneering robotic surgery for complex gynecologic conditions: implementation beyond cancer care

Abstract Minimally invasive surgery was introduced to minimize some of the issues associated with open surgery. Its benefits include fewer complications, less pain and blood loss, shorter hospital stays, quicker recovery, and less noticeable scars. While laparoscopy has been the gold standard for minimally invasive surgery, robot-assisted surgery has emerged as the latest major breakthrough for minimally invasive procedures, allowing surgeons to expand its use to more complex surgical procedures and operating with more precision, flexibility, control, and comfort than is possible with traditional procedures. Here we present the successful implementation of a robotic-assisted surgery program in the gynecology department of the Spanish tertiary hospital La Paz. This included the complete training of six surgeons from the three units in the department: oncology, pelvic floor, and benign organic pathology. By the end of 2024, 184 procedures had been conducted in the first year, including interventions for both cancer ( N  = 46) and benign pathologies ( N  = 138). In these, 2.2% of patients developed Clavien–Dindo grade 2 complications. The complexity of the procedures increased during implementation of the program, whereas hospitalization times and associated costs remained low.

Enhancing surgical performance: the role of robotic surgery in myomectomies, a systematic review and metanalysis

Examine the role, benefits, and limitations of robotic surgery in myomectomies compared to laparoscopic and open surgical approaches. This review sourced data from CENTRAL, Pubmed, Medline, and Embase up until May 1, 2023. Full articles comparing clinical outcomes of robotic myomectomy with open or laparoscopic procedures were included without language restriction. Initially, 2150 records were found. 24 studies were finally included for both qualitative and quantitative analyses. Two investigators independently assessed all reports following PRISMA guidelines. Meta-analysis was conducted using the software "Review Manager Version 5.4". Risk-of-bias was assessed using the Newcastle-Ottawa scale. Sensitivity analysis was conducted, when feasible. In a comparison between robotic and laparoscopic myomectomies, no significant difference was observed in fibroid weights and the size of the largest fibroid. Robotic myomectomy resulted in less blood loss, but transfusion rates were comparable. Both methods had similar complication rates and operative times, although some robotic studies showed longer durations. Conversion rates favored robotics. Hospital stays varied widely, with no overall significant difference, and pregnancy rates were similar between the two methods. When comparing robotic to open myomectomies, open procedures treated heavier and larger fibroids. They also had greater blood loss, but the robotic approach required fewer transfusions. The complication rate was slightly higher in open procedures. Open surgeries were generally faster, postoperative pain scores were similar, but hospital stays were longer for open procedures. Pregnancy rates were comparable for both robotic and open methods. Robotic surgery offers advancement in myomectomy procedures by offering enhanced exposure and dexterity, leading to reduced blood loss and improved patient outcomes. PROSPERO registration: CRD42023462348.

Same-day discharge after robotic surgery for endometrial cancer

To assess the safety of same-day discharge (SDD) following robotic-assisted endometrial cancer staging and identify risk factors for postoperative admission in a diverse population. A review of patients who underwent robotic-assisted endometrial cancer staging from April 1, 2017 to April 1, 2019 was performed. Patients were evaluated for SDD if they met the following criteria: tolerating oral intake, voiding spontaneously, ambulating, negative orthostatic vitals, postoperative hemoglobin ≤ 2 g/dL from baseline, pain controlled on oral medications, and desire to be discharged. Risk factors for admission were identified. One hundred eighty-seven patients were identified. SDD criteria were met in 158, of which 132 (83.5%) were discharged same day. Median length of stay was 4.5 h. Reasons for admission despite meeting criteria were late surgery time (n = 15), abnormal vitals (n = 9), and personal concerns (n = 2), with risk factors being age ≥ 68 years (OR 2.72; 95% CI, 1.13-6.59), start time 1400 or later (OR = 11.25; 95% CI, 4.35-29.10), ASA ≥ 4 (OR 23.82; 95% CI, 2.54-223.15), history of CVA/MI (OR 5.61; 95% CI, 1.07-29.52), and operative time ≥ 120 min (OR = 3.83; 95% CI 1.36-10.77). Of the SDD cohort, 2 patients (1.3%) presented to the emergency room within 30 days (postoperative day 5 and 23). SDD following robotic-assisted endometrial cancer staging is safe and feasible. Age ≥ 68 years, surgery start time after 1400, ASA ≥ 4, history of CVA/MI, and operative time ≥ 120 min appear predictive of inpatient admission despite meeting SDD criteria.

Adnexal mass management by minimally invasive surgery at a comprehensive cancer center

This study investigates methods of specimen extraction, pertinent clinical data and pathologic findings associated with minimally invasive surgery (MIS) for adnexal masses. This retrospective cohort study includes patients with an adnexal mass who underwent MIS removal. The association of categorical variables with adverse outcomes was investigated using Pearson chi-square or Fisher's exact test. Four hundred and thirty-eight patients met inclusion criteria. Surgical modalities included laparoscopic (n = 235, 53.7%), robotic (n = 165, 37.7%), and vaginal (n = 1, 0.2%). MIS was converted to laparotomy in 37 cases (8.4%). 203 (46.3%) specimens were removed vaginally, and 235 (53.7%) abdominally. Three hundred and nineteen (72.8%) specimens were removed intact whereas 119 (27.2%) were morcellated or drained 113 contained). Of the 6 uncontained morcellation cases, one was ovarian cancer, and one was a borderline tumor. For malignant histologies, receipt of adjuvant chemotherapy was not associated with specimen integrity (455 intact vs 12 morcellated, p = 0.207), route of specimen removal (31 vaginal vs 36 abdominal, p = 0.217), or use of a specimen bag (46 bag vs 21 no bag, p = 0.105). This study demonstrated that MIS is feasible in the majority of patients referred to our cancer center for an adnexal mass. Perioperative complications were uncommon. Management of the ovarian malignancies encountered in this cohort was not compromised by utilization of MIS.

Single incision robotic myomectomy: selection criteria, learning curve and cost

The article "Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases" by Kim et al. compares the effectiveness of robotic single-port myomectomy against the traditional multiport approach. The study finds similar operating outcomes, complication rates, and pregnancy rates in expert hands for both methods. Our systematic review supports these findings, revealing no significant differences in operative time, blood loss, or complication rates. Recent meta-analysis further emphasizes the benefits of the single-port approach in reducing morcellation time, overall operative duration, and blood loss. Our letter seeks insights on patient selection criteria to minimize conversion rates between surgical approaches and inquiries on learning curve differences. Additionally, we seek cost analysis details for both techniques. We appreciate the authors' valuable contributions to this field.

Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases

To assess the short-term operative and fertility outcomes of single-incision robotic myomectomy. We performed this retrospective cohort study of 286 women who underwent robotic single-site myomectomy using the da Vinci® Xi surgical system (RSSM group, n = 70) or robotic single-port myomectomy using the da Vinci® SP surgical system (RSPM group, n = 216). Data were collected through chart reviews and telephone interviews. Except operating time (94.6 ± 30.1 min in RSSM vs. 81.7 ± 20.1 min in RSPM) and location of the removed fibroids, there were no significant differences in the operative outcomes or characteristics of the removed fibroids between both groups. The proportion of fibroids in the lateral wall in RSPM (13.4%) was approximately twice that in RSSM (6.3%). There was no conversion to laparotomy or multiport access, and none of the women required readmission in either group. No significant difference in the complication rate was noted between groups, and all complications were resolved with conservative treatment. During the approximately 20-month follow-up period, in the RSSM and RSPM groups, the pregnancy rates were 54.5% and 67.4%, respectively, and the abortion rates were 33.3% and 22.6%, respectively. In terms of operative and fertility outcomes, single-site robotic myomectomy appears to be feasible and safe in women with symptomatic fibroids. The da Vinci® SP system is thought to be helpful in reducing operation time and surgically difficult myomectomy.

Impact of robotic surgery on patient flow and resource use intensity in ovarian cancer

There is an emerging focus on the role of robotic surgery in ovarian cancer. To date, the operational and cost implications of the procedure remain unknown. The objective of the current study was to evaluate the impact of integrating minimally invasive robotic surgery on patient flow, resource utilization, and hospital costs associated with the treatment of ovarian cancer during the in-hospital and post-discharge processes. 261 patients operated for the primary treatment of ovarian cancer between January 2006 and November 2014 at a university-affiliated tertiary hospital were included in this study. Outcomes were compared by surgical approach (robotic vs. open surgery) as well as pre- and post-implementation of the robotics platform for use in ovarian cancer. The in-hospital patient flow and number of emergency room visits within 3 months of surgery were evaluated using multi-state Markov models and generalized linear regression models, respectively. Robotic surgery cases were associated with lower rates of postoperative complications, resulted in a more expedited postoperative patient flow (e.g., shorter time in the recovery room, ICU, and inpatient ward), and were between $10,376 and $7,421 less expensive than the average laparotomy, depending on whether or not depreciation and amortization of the robotic platform were included. After discharge, patients who underwent robotic surgery were less likely to return to the ER (IRR 0.42, p = 0.02, and IRR 0.47, p = 0.055, in the univariate and multivariable models, respectively). With appropriate use of the technology, the addition of robotics to the medical armamentarium for the management of ovarian cancer, when clinically feasible, can bring about operational efficiencies and entails cost savings.

Adapting surgical skills from robotic-assisted radical hysterectomy in cervical cancer to uterine transplantation: a look to an optimistic future!

Uterus transplantation (UTx) is the first treatment for absolute uterine factor infertility. The first birth after human UTx in Sweden occurred in 2014 and very favourable results of the Swedish trial performed with laparotomy raised great hope. Several teams are leading their own trial among the world, but UTx is still in its experimental phase. Surgical intervention needs to be optimized. The long surgical duration (> 10 h), vascular dissection and risks of ureteral damages for live donors are major drawbacks. Minimal invasive surgery by means of robotic-assisted laparoscopy for live donors could become an improved option. Our collaborative Swedish-French team has initiated efforts to introduce minimal invasive surgery in one trial in Sweden and one in France. UTx is somewhat similar to a radical colpohysterectomy for arterial dissection. We describe a robotic-assisted radical colpohysterectomy and its transposition to uterus retrieval in a living donor. We report our experience on nine cases that were completed prior to our French UTx robot-assisted trial.

Analysis of abdominal vs. robotic radical hysterectomies for patients with cervical cancer: a Bulgarian experience

To assess and compare the peri-operative, oncologic, and survival outcomes for women with cervical cancer (CC) treated with abdominal radical hysterectomy (ARH) versus robotic radical hysterectomy (RRH) approaches in Bulgaria. We retrospectively analyzed patients with histologically diagnosed CC operated via ARH or RRH methods during January-2008 to April-2019. The data analyzed include patients and tumor characteristics, peri-operative outcomes, and disease status. Kaplan-Meier method and Cox regression analysis were performed to determine disease-free survival (DFS) and overall survival (OS). There were consecutive 1347 patients (ARH = 1006, RRH = 341), which formed the basis of study analyses. Women in the RRH group had significantly shorter median hospital length-of-stay than ARH cases (7 vs. 11 days, p < 0.001), higher post-operative hemoglobin (116 vs. 108 g/L, p < 0.001), and fewer blood transfusions (7.3% vs. 21.5%, p < 0.001), respectively. The overall incidence of post-operative complications was also lower in the RRH vs. ARH group (2.1% vs. 9.4%, p < 0.001). Median follow-up time for ARH vs. RRH groups was 4.32 vs. 5.24 years, respectively (p < 0.001). Kaplan-Meier analysis demonstrated that the RRH cohort had a significantly higher survival rate compared to the ARH group (CC-specific death 8.5% vs. 16.5% respectively). Mean time to recurrence did not differ significantly in either surgical approach (p = 0.495). Cox multivariate regression showed no significant impact of surgical approach on DFS or OS. No significant difference in DFS or OS between ARH vs. RRH for CC was observed. RRH approach does not lead to inferior oncologic outcomes and is associated with better peri-operative outcomes. In regard to "all stages" of CC, we found robotic surgery safer compared to laparotomy, and thus consider RRH a better surgical treatment option for patients with CC.

Robotic radical hysterectomy versus open radical hysterectomy for cervical cancer: a single-centre experience from India

To compare the disease-free survival (DFS) and overall survival (OS) at 3 years and 5 years in patients undergoing treatment for early-stage cervical cancer with either robotic (RRH) or open radical hysterectomy (ORH). This retrospective study compared all patients with stage IA1 (lymphovascular invasion), IA2, IB1, IB2 and II A cervical cancer in accordance with International Federation of Gynaecology and Obstetrics staging (FIGO 2009) of cancer of the cervix uteri. Patients who underwent Radical Hysterectomy at our centre from January 2011 till January 2018 were included in the study. One hundred and eighty-nine patients ( ORH = 67, RRH = 122) were included. The median follow-up time was 46.3 months in RRH group and 70.0 months in the ORH group. The 3-year DFS was comparable in both the arms, 91.5% in RRH and 91.6% in ORH. The 5-year DFS was 88.9% and 85.9% in robotic and open approaches, respectively (P = 0.258), hazard ratio (HR) 0.616 (CI = 0.266-1.427). The 3-year overall survival for robotic approach was 93.4% and for open was 95%, whereas 5-year overall survival was 84.7% and 87.4% in robotic and open approaches, respectively (P = 0.813). The median estimated blood loss for robotics was lower (100 ml vs 300 ml, P < 0.001) and median operative time was less (162.5 min vs. 180 min, P = 0.005) in robotics. The patients in RRH cohort had shorter median hospital stay (3.9 days vs. 6.3 days, P < 0.001). Robotic radical hysterectomy had comparable survival outcomes to open radical hysterectomy in cancer cervix. RRH is associated with improved peri-operative surgical outcomes and better resource utilisation.

Salvage robotic anterior pelvic exenteration for cervical cancer: technique and feasibility

The aim of our study was to explain the technique and evaluate the feasibility and safety of robotic anterior pelvic exenteration in cases of residual/recurrent cervical cancer as a salvage therapy. The study was conducted as a retrospective review of all the cases of central residual/recurrent cervical cancer who underwent anterior pelvic exenteration by robotic approach with curative intent at our centre between January 2013 and December 2019. Information regarding various treatment related parameters like duration of surgery, estimated blood loss, length of hospital stay, early and late complications and recurrence and survival was collected and evaluated. 14 patients underwent anterior pelvic exenteration by robotic approach in this period. The median age of patients at time of exenteration was 52.5 years. 13 out of 14 patients had received combined chemoradiation as a part of intial treatment. The median duration of surgery was 305 min with a median estimated blood loss of 135 ml and median length of hospital stay of 6.5 days. Early complications like urosepsis, uretero-ileal anastomotic leak and paralytic ileus occurred in 36% patients and late complications like ureteric stricture and bowel perforation occurred in 28.6% patients. Negative surgical margins could be achieved in all the patients. Over a median follow-up period of 17.5 months, five patients developed recurrence and five patients experienced mortality, with four out of five patients dying due to recurrent disease. The 12-month DFS was 68.2% and the 12-month OS was 77.1%. Robotic anterior pelvic exenteration is a safe and feasible option in selected patients with recurrent/residual cervical cancer as a salvage procedure, with acceptable morbidity and mortality.

Clavien–Dindo classification and risk prediction model of complications after robot-assisted radical hysterectomy for cervical cancer

Although significant progress has been made with surgical methods, the incidence of complications after minimally invasive surgery in patients with cervical cancer remains high. Established as a standardized system, Clavien-Dindo classification (CDC) has been applied in a variety of surgical fields. This study is designed to evaluate the complications after robot-assisted radical hysterectomy (RRH) for cervical cancer using CDC and further establish a prediction model. This is a study on the development of prediction model based on retrospective data. Patients with cervical cancer who received RRH treatment in our hospital from January 2016 to April 2019 were invited to participate in the study. The demographic data, laboratory and imaging examination results and postoperative complications were collected, and the logistic regression model was applied to analyze the risk factors possibly related to complications to establish a prediction model. 753 patients received RRH. The overall incidence of complications was 32.7%, most of which were grade I and grade II (accounting for 30.6%). The results of multivariate analysis showed that the preoperative neoadjuvant chemotherapy (OR = 1.693, 95%CI: 1.210-2.370, P = 0.002), preoperative ALT (OR = 1.028, 95%CI: 1.017-1.039, P < 0.001), preoperative urea nitrogen (OR = 0.868, 95%CI: 0.773-0.974, P = 0.016), preoperative total bilirubin (OR = 0.958, 95%CI: 0.925-0.993, P = 0.0.018), and preoperative albumin (OR = 0.937, 95%CI: 0.898-0.979, P = 0.003) were related to the occurrence of postoperative complications. The area under the curve (AUC) of receiver-operating characteristic (ROC) in the prediction model of RRH postoperative complications established based on these five factors was 0.827 with 95% CI of 0.794-0.860. In patients undergoing robot-assisted radical hysterectomy for cervical cancer, preoperative ALT level, urea nitrogen level, total bilirubin level, albumin level, and neoadjuvant chemotherapy were significantly related to the occurrence of postoperative complications. The regression prediction model established on this basis showed good prediction performance with certain clinical promotion and reference value.

Outcome of robot-assisted surgery for stage IA endometrial cancer compared to open and laparoscopic surgeries: a retrospective study at a single institution

Few studies have compared the efficacy of robot-assisted, laparoscopic, and open surgeries for endometrial cancer. When considering the position of robotic surgery in Japan, it was necessary to determine whether it was effective or not. We aimed to compare the efficacy and safety of these three types of surgeries for early-stage endometrial cancer. In total, 175 patients with endometrial cancer of preoperative stage IA, who had undergone laparotomic (n = 80), laparoscopic (n = 40), or robot-assisted (n = 55) modified radical hysterectomy at our hospital from 2010 to 2022, were included; surgical outcomes, perioperative complications, and prognoses were compared. Total operative and console times for robot-assisted surgery between patients who did or did not undergo pelvic lymphadenectomy were assessed. The robot-assisted group had the shortest total operative time. The estimated blood loss was lower in the laparoscopic and robot-assisted groups than in the laparotomy group. In advanced postoperative stage IA cases, there were no differences in progression-free and overall survival among the three groups. In the robot-assisted group, the operative time decreased as the number of operations increased; the learning curve was reached after 10 cases each of patients with and without pelvic lymphadenectomy. The frequency of perioperative complications of Clavien-Dindo classification Grade 1 or higher was the lowest in the robot-assisted group (p = 0.02). There were no complications of Clavien-Dindo classification Grade 2 or higher in the robot-assisted group. Robot-assisted surgery for stage IA endometrial cancer, a minimally invasive procedure, has fewer operative times and complications than those of laparoscopic and open surgeries in a single institution in Japan.

The da Vinci robotic surgery system for the management of endometrial cancer: a single-center experience

The aim of this study was to report our single-center experience of the da Vinci robotic surgery system in the management of endometrial cancer (EC) patients during 2019-2023. We descriptively summarized the preoperative, intraoperative, and postoperative outcomes. Moreover, we conducted subgroup analyses based on obesity (BMI ≥ 30 kg/m

Robot-assisted gynecologic surgery in elderly patients: perioperative outcomes and risk assessment in patients aged 70 years and older

Robot-assisted surgery has become widely accepted as a minimally invasive approach. However, its safety and feasibility in older women undergoing gynecologic procedures remain insufficiently explored. This retrospective study compared perioperative outcomes between two older age groups and evaluated surgical risks by using the E-PASS and POSSUM scoring systems. A total of 61 women aged ≥ 70 years who underwent robot-assisted gynecologic surgery at our institution were analyzed. Endometrial cancer cases involved hysterectomy with sentinel lymph node biopsy, while procedures for pelvic organ prolapse included sacrocolpopexy with vaginal surgery. The patients were categorized into pre-old (70-74 years) and old (75-89 years) groups. Although prior abdominal surgery was significantly more common in the old group (58.3 vs. 13.5%, p = 0.0003), no significant differences were found in comorbidities, the operative time (242 vs. 235 min), blood loss, or the duration of hospital stay. One pre-old patient developed a pelvic infection (Clavien-Dindo grade IIIa); no other serious complications occurred, and overall complication rates were similar. Two cases of postoperative delirium were not predicted preoperatively. Perioperative risk scores indicated a low risk in both groups. While midterm postoperative outcomes were generally favorable, some patients experienced new health-related events, which were unrelated to surgery. These findings suggest that robotic surgery is feasible and that age alone should not be a contraindication. However, importantly, these outcomes were achieved in a cohort that received comprehensive perioperative care; therefore, further studies with larger cohorts are needed. Moreover, perioperative planning should consider not only physical conditions but also the cognitive and mental status, the living environment, and social support.

Initial experience with the da Vinci SP robot-assisted surgical staging of endometrial cancer: a retrospective comparison with conventional laparotomy

To compare the perioperative outcomes of surgical staging performed using conventional laparotomy (LT) or the da Vinci SP robotic system (SP) in patients with endometrial cancer. We retrospectively analyzed 180 patients with stage I-III endometrial cancer who underwent surgical staging using LT (n = 126) or SP (n = 54) at the Yonsei Cancer Center between November 2018 and December 2022. Propensity score matching (PSM) was performed to mitigate potential confounding biases. Fifty-one pairs of patients were matched by PSM. SP required longer total operation time than LT (221 vs. 142 min in SP vs. LT, respectively, p < 0.001). However, estimated blood loss and postoperative hemoglobin change were lower in SP than in LT (30 vs. 100 mL, p < 0.001; 0.6 vs. 1.6 g/dL, p < 0.001 for SP vs. LT respectively). Furthermore, postoperative minor complications (13.7% in SP vs. 33.3% in LT, p = 0.02), perioperative transfusion rate (0% in SP vs. 11.8% in LT, p = 0.03), and postoperative hospital stay (2 days for SP vs. 8 days for LT, p < 0.001) were lower in SP than in LT. Although the patient-controlled analgesia administration rate was lower in SP (13.8% in SP vs. 100% in LT, p < 0.001), the median postoperative pain score at 6, 12, and 24 h after surgery was lower in SP than in LT (2 vs. 3, p = 0.002; 2 vs. 3, p = 0.005; 2 vs. 3, p = 0.001 for SP vs. LT, respectively). Although SP required longer total operation time, it demonstrated several advantages over LT in endometrial cancer staging.

Sentinel lymph node biopsy at robotic-assisted hysterectomy for atypical hyperplasia and endometrial cancer

Lymph node (LN) evaluation in endometrial cancer is controversial. Sentinel lymph node biopsy (SLNB) allows for an accurate nodal assessment while minimising the risks of a full pelvic lymph node dissection (PLND). The aims of this study are to examine the characteristics and peri-operative outcomes of women with atypical hyperplasia (AH) or endometrial cancer undergoing robotic-assisted hysterectomy (RAH) ± SLNB or PLND; to examine the utilisation, feasibility and role of SLNB and compare their peri-operative outcomes. Retrospective cohort study from December 2018 to February 2021 of women who underwent RAH ± LN assessment for endometrial cancer or AH. 115 women underwent RAH. 59% had SLNB, 29% had no LN assessment, and 12% had PLND. The final diagnosis was mostly early stage low-grade disease; Stage 1A-50%, Grade 1 endometrioid adenocarcinoma (EAC)-56%. The detection rate was 90%. There was a statistically significant trend towards performing SLNB over time (P value 0.004). There was a statistically shorter length of stay, less estimated blood loss, and shorter surgical duration in the SLNB cohort, compared to the no LN assessment cohort (P values 0.02, 0.01, and 0.03, respectively). There was statistically significant less estimated blood loss and surgical duration in the SLNB compared to the PLND cohort (P values 0.03 and 0.001, respectively). SLNB at RAH was utilised and feasible. It was safe with a low complication rate and had advantages compared to PLND cohort. SLNB should be considered in suitable selected women undergoing surgery for endometrial cancer or AH.

Outcomes of robotic surgery in morbidly obese patients with endometrial cancer: a retrospective study

With advances in minimal invasive surgery, robotic surgery has become the widespread approach for surgical staging of endometrial cancer in the obese population. This study aimed to evaluate safety and surgical outcomes of robotic surgery in the morbidly obese and extremely morbidly obese patients with endometrial cancer. Retrospective cohort study. A total of 391 obese women undergoing robotic-assisted surgical staging were identified and included in the study. Surgical outcomes for obese patients (BMI > 30 kg/m

Robotic versus laparoscopic hysterectomy in morbidly obese women for endometrial cancer

Surgery is the mainstay treatment for endometrial cancer and complex atypical endometrial hyperplasia. These conditions are more common in the obese women and as such these patients pose additional risks and challenges to surgery. Laparoscopic hysterectomy (LH) is preferred over open surgery in obese patients as it reduces surgical morbidity. However, more recently, robotic-assisted hysterectomy (RH) has been used in morbidly obese patients to overcome the limitations of conventional laparoscopy. To compare the surgical outcomes of morbidly obese patients undergoing LH or RH for endometrial cancer or complex atypical hyperplasia. A retrospective analysis of morbidly obese patients (BMI > 40 kg/m

Comparison of perioperative outcomes and technical features using da Vinci Si and Xi robotic platforms for early stages of endometrial cancer

We directly compared perioperative outcomes and technical features between previous da Vinci Si and the newer Xi robotic platform during total hysterectomy plus salpingo-oophorectomy with or without lymphadenectomy for early-stage endometrial cancer. We retrospectively analyzed147 patients with histological confirmation of endometrial carcinoma stage IA: grade 1-2, 3 and stage IB: grade 1-2 who underwent surgery with da Vinci Si or Xi system between January 2016 and December 2018. Perioperative data, technical features and postoperative complications were considered. 91 patients underwent surgery with the Si system and 56 with the Xi system. Docking time using the Xi system was significantly shorter (p < 0.002), while overall operating time was similar. There were no significant differences in the number of harvested lymph nodes, conversion rate, mean hospital stay, complications, and technical aspects between the two groups. Our study detected similar perioperative outcomes and the trend toward shorter docking and operating time for Xi over Si robot.

Robotic radical trachelectomy in early stage cervical cancer

Radical trachelectomy represents an alternative for early stage cervical cancer in patients who want to preserve fertility. This procedure can be performed by vaginal, open or minimal invasive approach. The robotic approach may offer some advantages, especially for the surgeon´s ergonomics. Since the evidence is still scarce, larger studies are needed. Our objective is to present a retrospective review of our experience with robotic radical trachelectomy. Descriptive study carried out in Clinico San Carlos University Hospital, Madrid, Spain. We included all our patients with early stage cervical cancer that wished to preserve fertility, from 2023 to 2022. The surgery included bilateral pelvic lymphadenectomy followed by radical trachelectomy and cervical cerclage after confirmation of absence of nodal metastasis. Demographic data of the study population, perioperative and oncological outcomes were analyzed. Seven patients who underwent radical robotic trachelectomy were studied. Median patient age was 30 (range 23-35) years. Median body mass index was 24 (range 19-28). Tumor histology was squamous cell carcinoma in 57% (4) and adenocarcinoma in 43% (3) of the patients. Median surgical time was 285 (range 247-315) min. The median of pelvic nodes obtained was 15 (range 12-40). Two postoperative complications were observed. One patient tried to conceived and had preterm labor. One patient died of the disease. In selected cases, robotic radical trachelectomy is a safe option for patients that wish to preserve their fertility with similar rates of oncological safety and complications than open procedures and a shorter recovery time.

Real-world outcomes of robotic and non-robotic hysterectomy for endometrial cancer: insights from a national cohort

To compare perioperative outcomes, postoperative complications, and overall survival among patients with endometrial cancer (EC) undergoing open hysterectomy (OH), laparoscopic hysterectomy (LH), or robot-assisted hysterectomy (RAH) using nationwide real-world data. This was a retrospective, population-based study using 2018-2020 Taiwan Cancer Registry who underwent one of three surgical approaches (open, laparoscopic, or robot-assisted) and outcomes were evaluated using NHIRD with follow-up data available through 2021. From these linked datasets, we identified 5,360 women diagnosed with endometrial cancer who received hysterectomy, including 3,176 cases of OH, 1,760 LH, and 424 RAH. Inverse probability weighting (IPTW) methodology was utilized to harmonize baseline characteristics across the study arms. Compared with OH, RAH was associated with significantly fewer transfusions (15.5% vs. 29.7% (p < 0.0001)), shorter hospital stays (5.9 vs. 8.0 days, p < 0.0001), and reduced intensive care utilization. At one month postoperatively, overall complication rates were markedly lower in the RAH group (0.95%) than in OH (7.52%) and LH (6.07%) (both p < 0.0001). Specific complications, including vascular events, cardiac events, stroke, pneumonia, peritonitis, and wound disruption, were significantly reduced with RAH. Mortality analysis showed that OH was shown higher mortality hazard ratios compared with RAH (HR 1.39, 95% CI: 1.20-1.61 after IPTW), while survival outcomes were similar between RAH and LH (HR 0.97, 95% CI: 0.73-1.28). RAH for endometrial cancer demonstrated significant perioperative and postoperative advantages compared with OH, including lower complication rates and improved survival outcomes. RAH outcomes were largely comparable to laparoscopic hysterectomy. These findings support broader consideration of RAH as a safe and effective minimally invasive approach for EC management in real-world practice, although further long-term evaluation is warranted.

Pioneering telesurgery in gynecology: the first European case of total hysterectomy

Abstract This report describes the first European clinical case of robot-assisted telesurgery in gynecology using the Toumai® Endoscopic Surgery System. A 34-year-old woman with recurrent cervical glandular intraepithelial neoplasia underwent a total hysterectomy with bilateral salpingectomy. The procedure was performed remotely between two institutions in Belgium, approximately 20 km apart. The remote surgeon operated from a dedicated console, while the patient and the surgical team were on site. The operation was completed successfully without intraoperative complications or conversion. Total operative time was 74 min, with a console time of 47 min. The mean latency was 20 ms with a jitter &lt; 10 ms, with high image quality and no connection issues. Postoperative recovery was uneventful, and the patient was discharged on day 2. At the 18-day follow-up, no complications were observed. Subjective feedback highlighted a high level of satisfaction among the patient and surgical staff, with the remote surgeon reporting a slightly reduced sense of control, mitigated by the on-site stand-by surgeon. Poor audio quality was noted as a minor issue. This first experience confirms that telesurgery in gynecology is technically feasible and safe, even using a standard network connection. Although further improvements and larger studies are needed, this experience supports telesurgery as a promising tool to expand access to expert surgical care.

Comparison of surgical and oncological outcomes between different surgical approaches for overweight or obese cervical cancer patients

AbstractThe purpose was to investigate the safety and advantages of different surgical approaches applied to overweight or obese cervical cancer patients by comparing their surgical and oncological outcomes. This is a retrospective cohort study. 382 patients with a body mass index of at least 24.0 kg/m2 and stage IB-IIA (The International Federation of Gynecology and Obstetrics, FIGO 2009) cervical cancer were enrolled, and then were divided into three groups: open radical hysterectomy (ORH) group, laparoscopic radical hysterectomy (LRH) group, and robot-assisted radical hysterectomy (RRH) group according to the surgical approach. IBM SPSS version 25.0 was used to analyze data. There were 51 patients in ORH group, 225 patients in LRH group and 106 patients in RRH group. In the comparison of surgical outcomes, compared to LRH and ORH, RRH had the shortest operating time, the least estimated blood loss, the shortest postoperative hospital stay, and the shortest recovery time for bowel function (P &lt; 0.05). In the comparison of postoperative complications, ORH has the highest rate of postoperative infection and wound complication compared to LRH and RRH (P &lt; 0.05), and RRH has the highest proportion of urinary retention. After a median follow-up time of 61 months, there was no statistically significant difference between the three groups in terms of 5-year overall survival (OS) rate and 5-year recurrence-free survival (RFS) rate, (P = 0.262, P = 0.453). In patients with overweight or obese cervical cancer, the long-term outcomes of the three surgical approaches were comparable, with RRH showing significant advantages over ORH and LRH in terms of surgical outcomes.

Feasibility and surgical outcomes of robotic myomectomy for large and multiple uterine fibroids- insights from a decade of experience at a single centre

There is limited data on the safety and effectiveness of robotic-assisted myomectomy (RM) for large (≥ 8 cm) and multiple (≥ 5) fibroids. This study aims to assess the feasibility and perioperative outcomes of RM in these cases. A retrospective chart review was performed on 260 patients who underwent RM at a single institution between January 2013 and May 2024. Demographic information, primary symptoms, and operative outcomes were extracted from the patients' medical records. Large myomas were defined as those with a diameter of ≥ 8 cm, while multiple myomas were considered to be ≥ 5 fibroids. Data from 260 patients, with a mean age of 34.18 ± 5.55 years, were collected and analyzed. On average, 2.37 ± 0.31 fibroids were removed, with a mean weight of 294.0 ± 290.25 g. The average operative time was 144.6 ± 55.3 min, including a console time of 100.3 ± 47.13 min. The estimated blood loss (EBL) averaged 189.05 ± 296.65 mL, with 6.9% (18 patients) requiring transfusions. The mean hospital stay was 23.46 ± 6.42 h, with 87 patients staying more than 24 h. No conversions to laparotomy, reoperations, or major complications were reported. Patients with fibroids ≥ 8 cm experienced significantly higher EBL (p = 0.019), transfusion rates (p = 0.041), and longer hospital stays (p = 0.009). Although total operative time was not significantly affected by the number of fibroids, docking (p = 0.036) and console times (p < 0.001) were longer in patients with ≥ 5 fibroids. Additionally, blood transfusions were more frequently required in this group. Drawing on ten years of experience, this study highlights the feasibility and efficacy of RM in treating uterine myomas larger than 8 cm and in cases involving five or more fibroids.

Annual nationwide cost estimation and short-term outcomes after para-aortic lymph node dissection for gynecologic malignancies according to surgical approach (open, laparoscopic, and robotic)

Global research landscape of robotic surgery in gynecologic oncology: a bibliometric analysis (2005–2025)

Saturation of respiratory strain during robotic hysterectomy in obese women with endometrial cancer

To evaluate intraoperative ventilatory mechanics during robotic-assisted hysterectomy in obese women with endometrial cancer and introduce the concept of a physiologic "ceiling effect" in respiratory strain. We conducted a retrospective cohort study of 89 women with biopsy-confirmed endometrial cancer who underwent robotic-assisted total hysterectomy between 2011 and 2015. Intraoperative ventilatory parameters, including plateau airway pressure and static lung compliance, were recorded at five-minute intervals. Each patient's peak plateau pressure was identified to calculate static compliance and estimate maximum ventilatory strain. Patients were stratified by body mass index (BMI), and ventilatory parameters were compared across BMI categories at baseline (post-induction, supine) and during steep Trendelenburg positioning with carbon dioxide pneumoperitoneum. At baseline, increasing BMI was significantly associated with higher plateau airway pressure and lower static compliance. For example, plateau pressure increased from 18.6 ± 3.4 cm of water (cm H₂O) in patients with BMI less than 30 kg per square meter to 25.9 ± 3.3 cm H₂O in those with BMI greater than or equal to 50 (p < 0.001). However, following Trendelenburg positioning with pneumoperitoneum, peak plateau pressures converged across BMI categories, averaging 35.0 ± 3.3 cm H₂O (p = 0.167). Static compliance also converged across BMI strata, averaging 17.2 ± 4.2 ml per cm H₂O (p = 0.129). Pulmonary complications occurred in 4.5% of patients, with no cases of barotrauma or prolonged mechanical ventilation. Intraoperative ventilatory strain appears driven primarily by surgical positioning and pneumoperitoneum, rather than obesity alone. These findings support the feasibility and safety of robotic-assisted hysterectomy across a wide range of body mass index values and introduce the novel concept of a physiologic ceiling effect in ventilatory stress.

Robotic omentectomy in gynecologic oncology: surgical anatomy, indications, and a technical approach

An omentectomy is a standard component care of gynecological cancers, particularly for surgical staging and treatment for malignant ovarian neoplasms, borderline tumors, fallopian tube cancers, primary peritoneal cancers as well as certain histological subtypes of endometrial cancer. Traditionally, an omentectomy is performed by an open laparotomy approach, however, use of a robotic approach has gained popularity and has been proven to be both safe and effective. In spite of the advantages of robotic surgery compared to laparotomy, the inherent technical challenges of a robotic omentectomy may limit its uptake. In this article, we review (1) the physiology and surgical anatomy of the omentum, (2) the role of the omentum in immune regulation and oncogenesis, (3) indications for an omentectomy in the setting of gynecological malignancy, and (4) describe a step-by-step 3-arm technique for performing both a infracolic and gastrocolic omentectomy procedure using a robotic approach.

Robotic interval debulking surgery for advanced epithelial ovarian cancer: current challenge or future direction? A systematic review

We evaluated the effectiveness, safety and efficacy of robotic interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) treated with neoadjuvant chemotherapy (NACT). We conducted a systematic review of the published relevant studies. Α total of 102 patients were evaluated. Mean operative time ranged from 164 to 312 min (mean ± SD: 246 ± 61 min) while mean estimated blood loss ranged from 106.9 to 262.5 ml (mean ± SD: 168 ± 68 ml) and postoperative blood transfusion rate was 19% (n = 19/98). Complete cytoreduction rate (R0 resection) was achieved in 75 patients (76.5%), whereas residual disease ≤ 1 cm in 21 women (21.5%). Mean hospital stay was 2.4 days. No intraoperative and six postoperative (14.6%) complications were reported. Laparotomy conversion rate was 9.2% (9/98) mostly in the terms of achieving complete cytoreduction and 30-day mortality rate was 9.2% (n = 9/98). The median overall survival varied from 39.7 to 47.2 months, while the progression-free survival ranged from 20.6 to 21.2 months during a median follow-up period from 2 to 86 months (median 25.3 months). A total of 60 women (61%) developed disease recurrence. One of the studies reported significantly improved OS and PFS in patients who underwent robotic IDS when compared to those who had laparotomy either during or before the addition of robotic surgery in the management of advanced ovarian cancer disease (47.2 vs 37.8 vs 37.9, p = 0.004 for OS and 20.6 vs 13.9 vs 11.9, p = 0.005 for PFS, respectively). The same was also observed when controlling the parameters of age and stage for patients in the robotic arm (p = 0.02). Robotic interval debulking surgery can be considered in the management of advanced ovarian cancer patients after receiving neoadjuvant chemotherapy. Larger meta-analyses including multicenter randomized control trials are necessary to specify the exact profile of the patients that could benefit from this treatment strategy.

Advanced robotic surgery in obese patients with gynecological cancers: tips and tricks from literature to clinical practice

Obesity is closely linked to an increased incidence of several gynecological conditions and poses significant challenges to their surgical management. Among these, endometrial cancer stands out due to its high prevalence in patients with elevated body mass index, with nearly 60% of those requiring primary surgical treatment classified as obese or morbidly obese. The coexistence of multiple comorbidities in this population contributes to a heightened risk of perioperative and postoperative complications. Robotic-assisted surgery has emerged as a key advancement in minimally invasive gynecologic procedures, offering meaningful clinical advantages over conventional laparoscopy. These include decreased intraoperative blood loss, reduced complication rates, and shorter recovery times. Such benefits are particularly advantageous in obese patients, where robotic techniques are associated with significantly lower rates of conversion to laparotomy. Nonetheless, the surgical care of these patients remains complex and requires the coordinated expertise of seasoned surgical and anesthetic teams. The aim of this review is to provide evidence-based tips and techniques for performing successful minimally invasive robotic-assisted procedures in obese patients. This paper will review current evidence on: (1) operating room setup and patient preparation; (2) robotic port placement strategies; (3) pneumoperitoneum establishment and physiological considerations; (4) intraoperative techniques and (5) practical solutions for addressing challenges in retroperitoneal staging.

Management of aberrant crossing of superficial external pudendal artery during robotic video-endoscopic inguinofemoral lymphadenectomy: a video case study

Inguinofemoral lymphadenectomy remains a critical component of staging and treatment for vulvar and penile squamous cell carcinoma. Traditionally performed via an open approach, this procedure is associated with significant morbidity, including lymphocyst formation, chronic lymphedema, and delayed recovery. A minimally invasive alternative, via laparoscopic or robotic platforms, is gaining traction as it is associated with a lower risk of surgical morbidity. However, this approach presents specific technical challenges due to confined dissection planes and limited surgical exposure. This paper highlights a clinically significant vascular variant encountered during robotic inguinofemoral lymphadenectomy, namely the aberrant course of the superficial external pudendal artery (SEPA) as it crosses anterior to the great saphenous vein near the saphenofemoral junction. While typically located beneath the great saphenous vein, this variation places the SEPA at risk of injury during nodal dissection leading to torrential bleeding. We present a stepwise surgical video demonstrating the safe identification, dissection, and ligation of an aberrant SEPA during robotic-assisted video-endoscopic inguinal lymphadenectomy (R-VEIL). The protocol includes systematic nodal mobilization, identification of anatomical landmarks, and vascular control techniques. Recognition and management of SEPA variants are essential to avoid complications and optimize outcomes. Given the rarity of vulvar and penile cancers, this video serves as an educational tool to improve surgical safety and enhance confidence in managing vascular anomalies during minimally invasive groin dissection.

Sentinel lymph node and operative outcomes in patients with endometrial cancer and a BMI ≥ 50: the SLOPE-50 study

Women with BMI ≥ 50 kg/m

Patient-related factors for surgical modality selection in early-stage endometrial cancer: a retrospective comparative study of laparoscopic and robotic surgery

Several studies have compared surgical outcomes between laparoscopic and robotic surgery for endometrial cancer. However, there are no clear recommendations for selecting between the two minimally invasive surgery (MIS) approaches. This study aimed to compare the performance of the two MIS approaches in early-stage endometrial cancer and to identify patient-related factors influencing modality selection. We included patients who underwent laparoscopic or robotic surgery for preoperative clinical stage IA endometrial cancer at Kanagawa Cancer Center between May 2020 and August 2024. The choice of surgical modality was not entirely random and was primarily influenced by equipment availability. We compared surgical outcomes and analyzed factors associated with longer operative time and greater estimated blood loss. Overall, 204 patients were enrolled, with 95 (46.6%) in the laparoscopic group and 109 (53.4%) in the robotic group. The laparoscopic group had shorter operative times and greater estimated blood loss than the robotic group. Multivariable analyses showed that a robotic approach and a body mass index (BMI) of 30 or higher were associated with longer operative times. No factors were significantly associated with estimated blood loss. Subgroup analyses revealed that operative time was significantly shorter only among patients with BMI < 30 undergoing laparoscopic surgery (hazard ratio = 1.94; 95% confidence interval, 1.34-2.82), highlighting the impact of BMI on surgical efficiency. During a median follow-up period of 21.0 months, no recurrences were observed in either group. In institutions offering both laparoscopic and robotic surgery, a BMI of 30 may serve as a practical threshold for selecting the MIS modality in early-stage endometrial cancer. 2024 Eki 15, data of registration: 20th January 2025, retrospectively registered.

Robot-assisted hysterectomy for endometrial cancer: is there a correlation between uterine diameters, pelvic volume, and surgical outcomes?

Hysterectomy could be performed through a vaginal approach, laparotomy, or laparoscopy. Robotic surgery is a technique that can be defined as a particular type of laparoscopy, often used in interventions where microsurgery can help improve radicality and effectiveness. In choosing patients for the robotic technique, many characteristics could be studied to tailor the surgical choice. Our aim is to describe the anthropomorphic and radiological parameters linked to worse surgical outcomes for the potential stratification of patients in the preoperative decision about the type of surgery. In our center, the AOU Maggiore della Carità Hospital in Novara (Italy), 104 patients diagnosed with endometrial cancer and candidated for total hysterectomy, with various degrees of radicality, underwent robotic surgery. Patients' anthropomorphic parameters, such as body mass index, and radiological imaging such as uterine size and pelvis diameter, were compared with the surgical outcomes such as operating times, complications as blood loss, subsequent emergency room visits, and the possible need for laparotomy conversion. Our ratios between pelvic depth and uterine anteroposterior diameter (PD/UAP) and between uterine volume and pelvic volume index (UV/PCI) showed statistically significant correlations with surgical time.

Specimen extraction techniques utilized in minimally invasive surgery for uterine cancer and an enlarged uterus: a quality assurance study

This study was conducted to investigate the techniques and complications of enlarged uterine extraction during minimally invasive surgery for uterine malignancy. The electronic medical record was queried for patients with uterine malignancy and enlarged uterus (≥ 250 g) who underwent primary hysterectomy with laparoscopic or robotic approach. Statistical analysis was performed using Fisher's exact test for categorical variables and Kruskal-Wallis test for continuous variables. All patients with presumed uterine confined endometrial cancer who underwent upfront surgical management with minimally invasive hysterectomy and had uterine specimen weight ≥ 250 g were included. Seventy-eight patients met inclusion criteria. Mean specimen weight and mean operating time differed by extraction technique: intact vaginal extraction 307 g, 163 min; vaginal removal in specimen bag 337 g, 214 min; incidental vaginal morcellation 321 g, 178 min; vaginal morcellation in specimen bag 361 g, 212 min; and small laparotomy 677 g, 237 min. Specimens that required removal with small laparotomy incisions were larger in weight (p = < .001) and had increased operative time (p = < .001). Adjuvant treatment was given to 52.6% (41/78) of patients; 36.6% (15/41) received chemotherapy and 63.4% (26/41) received radiation. Rates of adjuvant radiation differed among extraction techniques (p = .018). Recurrence rates (n = 8) and patient death (n = 6) were not associated with extraction techniques (p = .408 and p = .537, respectively). Adjuvant radiation rates were statistically different among extraction techniques. Specimens removed by small laparotomy were significantly larger and required greater operative time. This study demonstrated that minimally invasive surgery was feasible in patients with uterine malignancy and an enlarged uterus.

Advantages of robotic single-port hysterectomy compared to robotic multiport hysterectomy on clinical and aesthetic outcomes in patients with endometrial cancer

Robotic multiport (RMP) and single-site (RSS) hysterectomies are minimally invasive surgical techniques increasingly employed in the treatment of endometrial cancer. This study assesses whether RSS provides distinct therapeutic and aesthetic benefits compared to RMP, such as fewer and smaller incisions, which enhance cosmetic satisfaction and expedite postoperative recovery. A retrospective analysis of comparative research on RSS and RMP in endometrial cancer was performed utilizing PubMed and Google Scholar. Only publications in the English language from 2019 to 2025 were included. Studies were chosen based on their assessment of clinical results (e.g., operation duration, complications, hemorrhage, recovery time) and cosmetic outcomes (e.g., scar visibility, incision attributes, patient satisfaction). RSS correlated with reduced hospital durations, diminished postoperative discomfort, expedited recovery, and enhanced cosmetic outcomes attributable to fewer and smaller incisions. Both approaches exhibited similar safety profiles regarding blood loss, complication rates, and lymph node evaluation. RSS was associated with increased patient-reported satisfaction and enhanced postoperative physical performance. Nevertheless, characteristics such as BMI, comorbidities, and surgeon experience were evaluated inconsistently across trials, underscoring the lack of standardized reporting and the necessity for rigorously controlled research assessing these factors. RSS demonstrates enhanced aesthetic results and comparable clinical safety relative to RMP, rendering it a preferable choice for patients who prioritize recovery and cosmetic appearance. These findings can also guide tailored surgical planning and improve patient counseling in gynecologic oncology. Future randomized trials with a wider patient demographic and extended follow-up are crucial to validate these findings and evaluate their oncological longevity.

Robotic surgery in endometrial cancer: first Polish experience

In Poland, robotic surgery is nowadays perceived as a new method of surgical treatment in endometrial cancer patients. We aim to present the first Polish group of endometrial cancer patients treated using robotic surgery. The analysis was based on 79 patients with mean age of 59.72 ± 11.709 (range 27-83) years and endometrial cancer scheduled for surgical treatment. Mean BMI was 31.38 ± 8.78 (range 19.03-65.97) kg/m

Parameters that may affect detection rates of SLN in morbidly obese patients with endometrial cancer and changes in everyday practice