SIMPLE HYSTERECTOMY USING THE DA VINCI S ROBOTIC SYSTEM FOR BENIGN UTERINE TUMORS

Objective. To make a primary analysis of robot-assisted simple laparoscopic hysterectomies using the da Vinci S. robotic complex. Subjects and methods. In March 2009 to August 2011, the Clinic of Female Diseases and Reproductive Health, N.I. Pirogov Research Medical and Surgical Center, Ministry of Health and Social Development of Russia, followed up 33 women aged 38 to 63 years (mean age 46.3±5.8 years) with benign uterine and ovarian tumors. The patients’ weight was 48.4 to 106.43 kg (mean 77.4±2.7 кг); body mass index was 21.9 to 33.25 kg/m 2 (mean 26.07±0.4 kg/m 2). All the 33 patients underwent 27 simple hysterectomies and 6 supravaginal uterine amputations, by applying the da Vinci S robotic system. Uterine myoma was concurrent with adenomyosis in 3 patients, with benign ovarian neoplasms and fallopian tube abnormalities in 9, and endometrial hyperplasia in 4. The uterus varied 7 to 16 weeks’ gestational size (mean 12.4±2.6 weeks). Criteria, such as the time of surgical intervention, a surgeon’s console work, and anesthesia, the volume of blood loss, and intraoperative and postoperative (up to 6 weeks) complications, were estimated. Results. The robotic expansion and set-up time averaged 17.8±2.09 min (range 20.4—180.6 min). The duration of skin-to-skin (i.e. first-to-last incision) surgery was 184.7±10.2 min (range 78.5—215.9 min). The mean surgical duration (the time of a surgeon’s console work) was 156.34±54.36 min. Intraoperative blood loss averaged 97.0±65.43 ml (range 50.3—150.2 ml). There were no intraoperative or early postoperative complications. In one case, there was a conversion switch from robot-assisted laparoscopy to conventional one because of the uterus being enlarged 16-18 weeks’ gestational size and two myomatous nodules being located low, which limited to a greater extent the feasibility of abdominal manipulations. The surgery was completed laparoscopically. Conclusion. A great breakthrough has been made during 200 years of gynecological operations, simple hysterectomies in particular. Technological progress has contributed to the enormous improvement and promotion of simple hysterectomies from the laparotomy developed by E. McDowell to the robotic system.

intuitive surgery, robot-assisted hysterectomy, da Vinci surgical system