Robotic Surgery: Advancements and Inflection Points in the Field of Gynecology

On-demand robotic surgery for hysterectomies: A combination of the best of robotic and laparoscopic approach

BACKGROUND

The advantage of robot-assisted hysterectomy over standard laparoscopy remains controversial. Conventional robots offer limited flexibility to the surgeon. The novel, Dexter robotic system™, allows integration and easy switch between the laparoscopic and robotic interface.

OBJECTIVES

This study's objective is to evaluate the feasibility of using Dexter for robot-assisted laparoscopic hysterectomies by analyzing surgical data and intra- and postoperative complication rates.

DESIGN

Retrospective study.

METHODS

Women who underwent surgery using the Dexter robotic system at a University Hospital in Switzerland from March to December 2022 were included in this study. A comprehensive database containing coded demographic and clinical outcome data for these patients was analyzed for surgical data and intra- and postoperative complications.

RESULTS

We collected and evaluated data from 24 patients who underwent Dexter robot-assisted hysterectomies for indications like endometrial cancer, endometriosis, and uterine fibroids. For all patients, a hysterectomy was accompanied by other procedures such as radical lymphadenectomy or deep infiltrating endometriosis surgery that was mostly performed by conventional laparoscopy. The mean operating time was 171.9 min, with an average estimated blood loss of 130.8 ml. The patients stayed at the hospital for an average of 4 days. Clavien-Dindo grade III postoperative complications were reported in four patients with three vaginal dome infections and one umbilical (camera arm) trocar hernia. Importantly, there were no intraoperative complications or conversion to laparotomy among the operated patients.

CONCLUSION

We present the first retrospective study reporting the feasibility of Dexter in robot-assisted laparoscopic hysterectomies. All surgeries were performed successfully without technical failure or device-related adverse events. In contrast to the other robotic systems, Dexter offers an on-demand platform, allowing the surgeon to switch between laparoscopic and robotic interfaces as required. Further research is needed to validate its potential advantages and broader applicability.

Proficiency Levels and Validity Evidence for Scoring Metrics for a Virtual Reality and Inanimate Robotic Surgery Simulation Curriculum

OBJECTIVE

Our institution recently implemented a virtual reality (VR) skills curriculum for general surgery residents using the SimNow simulator. Based on a content alignment study, we revised the curriculum to include only 20 of 33 VR tasks and we added 3 previously validated inanimate tasks. The purpose of this study was to establish expert-derived proficiency levels for all tasks and to evaluate the validity of the scoring for the VR tasks.

DESIGN

Two expert robotic surgeons performed 5 repetitions of each VR and inanimate task. The trimmed mean (lowest scoring attempt and outliers [>2 standard deviations] were eliminated) was defined as the expert level for each task. For the VR tasks, expert levels were compared to resident performance to evaluate validity.

SETTING

This study was conducted at the University of Texas Southwestern Medical Center (Dallas, TX), a tertiary care academic teaching hospital.

PARTICIPANTS

Two expert robotic surgeons participated in this study. The data from 42 residents (PGY2-4) who completed the original curriculum was used to represent novice performance.

RESULTS

Comparison of expert levels and resident performance was statistically significant for 15 VR tasks (supporting validity) and approached significance (p = 0.06, 0.09) for 2 VR tasks; expert levels were designated as proficiency levels for these 17 tasks. Group comparisons were clearly not significant (p = 0.2-0.8) for 3 VR tasks; 2 of these 3 tasks were retained as introductory exercises (with 3 repetitions required) and 1 was excluded. For the 3 inanimate tasks, expert levels minus 2 standard deviations were designated as proficiency levels.

CONCLUSIONS

This analysis generated validity evidence for 15 VR tasks and established expert-derived proficiency levels for 17 VR tasks and 3 inanimate tasks. Our proposed curriculum now consists of 19 VR and 3 inanimate tasks using the selected proficiency levels. We anticipate that this design will maximize curriculum efficiency and effectiveness.

Global research hotspots and trends on robotic surgery in obstetrics and gynecology: a bibliometric analysis based on VOSviewer

Objective

Over the last two decades, the quantity of papers published in relation to robotic surgery in obstetrics and gynecology has continued to grow globally. However, no bibliometric analysis based on VOSviewer has been performed to evaluate the past and present of global research in the field. In this study, we aimed to analyze the bibliometric characteristics of papers on robotic surgery in obstetrics and gynecology to reveal research hotspots and trends in this field.

Methods

The Web of Science Core Collection was searched for scientific papers on robotic surgery in obstetrics and gynecology published between January 1, 1998 and December 31, 2023. Bibliometric metadata of each selected paper was extracted for analysis. The results were visualized by VOSviewer (version 1.6.18).

Results

A total of 1,430 papers met the inclusion criteria. The United States had the highest total link strengths and contributed the most papers (n = 793). The Mayo Clinic produced the largest number of papers (n = 85), and Professor Pedro T Ramirez contributed the most papers (n = 36). The number of citations ranged from 0 to 295 with a total sum of 29,103. The Journal of Minimally Invasive Gynecology published the most relevant papers (n = 252). Keywords were classified into six clusters based on co-occurrence data, of which cluster 1, cluster 4 and cluster 6 had more main keywords with the largest average publication year.

Conclusions

This is the first VOSviewer-based bibliometric analysis of robotic surgery research in obstetrics and gynecology. The United States was the leading country, and the Journal of Minimally Invasive Gynecology was the most productive journal in the field. Scientists and institutions from around the world should push their boundaries to bring about deep collaboration. The main research topic has always been the use of robotic surgery in the treatment of gynecologic malignancies. More randomized controlled trials need to be conducted to compare surgical outcomes of robotic surgery with other surgical approaches. Robotic sacrocolpopexy for pelvic organ prolapse has become a new research hotspot, and robotic surgery for sentinel lymph node detection in gynecologic malignancies are more potential directions for future research.

Expanding Robotic-Assisted Surgery in Gynecology Using the Potential of an Advanced Robotic System

Minimally invasive surgery (MIS) in gynecology was introduced to achieve the same surgical objectives as traditional open surgery while minimizing trauma to surrounding tissues, reducing pain, accelerating recovery, and improving overall patient outcomes. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, have become the standard for many gynecological procedures. In this review, we aim to summarize the advantages and main limitations to a broader adoption of robotic-assisted surgery compared to laparoscopic surgeries in gynecology. We present a new surgical system, the Dexter Robotic System™ (Distalmotion, Switzerland), that facilitates the transition from laparoscopy expertise to robotic-assisted surgery.

Technological Advances in Electronics and Computing for Elderly Healthcare

---