Abstract


Introduction: Robotic systems provide a platform for surgeons to expand their capabilities, allowing them to perform complex procedures safely and efficiently. Within the field of benign gynecology, this has become an increasingly popular option since receiving Food and Drug Administration (FDA) approval in 2005. However, the appropriate indications for robotic versus laparoscopic surgery continue to be debated.
Materials and Methods: Literature was reviewed to provide a comprehensive, evidence-based evaluation of the advantages and pitfalls of robotic surgery, the applications of robotic surgery for benign gynecologic procedures in comparison to conventional laparoscopy, and the role of robotic surgery as an educational tool.
Results: Robotic surgery has favorable outcomes for surgeons in the areas of ergonomics, dexterity, and fatigue. Cost comparisons are widely varied and elaborate. Most patient outcomes are comparable between robotic and laparoscopic hysterectomies and endometriosis resections. In patients with a body mass index >30mg/m2 and uteri >750mg, hysterectomy outcomes are improved when surgery is done robotically. The use of the robotic system may be beneficial for patients undergoing myomectomy. Robotic surgery confers advantages for trainees and novice surgeons. There is no consensus on a standardized curriculum for robotic training or credentialing process for experienced surgeons.
Conclusion: Robotic surgery has distinct features that make it a valuable tool for gynecologic surgeons. There are no clear indications regarding when a robotic route should be chosen but could be considered when above average complexity is anticipated and when training new surgeons.

Abstract


In Part I of this three-part series, the author reviewed the importance of resectoscopic surgery and the many advantages it provides to the patient and to the minimally invasive gynecologic surgeon. In Part I, we reviewed the obstacles to mastering this 30-year-old technology and how the motivated surgeon can overcome them. Although many basic resectoscopic procedures have been supplanted by global endometrial ablation (GEA) devices and hysteroscopic morcellators (HMs), the limitations of these restrictive technologies are quickly evident as the surgeon encounters increasingly complex and demanding cases.
In Part II, the author examines intermediate-level procedures that cannot be managed with global endometrial ablation or hysteroscopic morcellators—endomyometrial resection (EMR), the resection of larger and multiple submucous leiomyomas and endometrial polyps, the incision of uterine septae, and the management of severe cervical stenosis. In Part II, we will also describe how to incorporate ultrasound guidance into one’s surgical armamentarium and its role in assisting the minimally invasive gynecologic surgeon in the safe execution of these more challenging cases.