Robotic Surgery

Dear Colleagues,

Robot-assisted laparoscopy (RAL) has greatly improved in recent years. Hospitals have quickly acquired robotic technology and commonly use it in gynecological surgery. Robotic surgery (RS) offers patients the benefits of minimally invasive surgery (MIS): a shorter hospitalization, less pain and scarring, less risk of infection, less blood loss and fewer transfusions, faster recovery and return to normal activities. RAL overcomes many of the difficulties associated with standard laparoscopy through improved high-definition 3D vision, improved mobility, surgical dexterity, and ergonomics 
RS enhances complex oncological procedures, such as radical hysterectomy, which requires delicate and precise dissection of the area. It has recently become an option for definitive surgical management of early stage tumors of the endometrium and cervix. MIS in the management of cancer of the endometrium, in which obesity has been associated with an increased incidence of this tumor, has been shown to be the surgical technique of choice. The conversion rate to an open procedure is proportional to the increase in BMI, as the thickness of the abdominal wall may limit operational movements and cause difficulties in accessing the peritoneal cavity. RS has been shown to overcome these limits.

The concept of robotic surgery is also suitable for deep pelvic lymphadenectomy (RPDL).

RPDL allows adequate surgical dissection with an improved post-operative result, minimal morbidity, and more accurate dissection of the lymph nodes. Due to its wide range of indications, RAL also seems viable for the treatment of deep infiltrating endometriosis (DIE). RAL provides a precise dissection of the pelvic area, allowing excellent visualization of the nerves of the pelvic plexus, the ablation of endometriosis, and the lysis of existing adhesions decreasing the possibility of pelvic infection and adhesion formation, crucial issues in accounting for future fertility.

Given the high rate of surgical treatment for pelvic organ prolapse (POP), there is the robotic assisted laparoscopic sacrocolpopexy (RALS) which can provide the same long-term success as an open sacrocolpopexy but with the advantage of MIS. This can be performed in the same time as the supracervical assisted robotic hysterectomy (SRAH). 

Dr. Gianluca Raffaello Damiani
Guest Editor

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