#432 - Review of Robotic Surgery in Gynecology

Robotic Surgery in Gynecology Rambam Maimonides Medical Journal 2 April 2017  Volume 8  Issue 2  e0019 quite a fewmore randomized controlled clinical trials. In any case, in order to bring robotic surgery down to the front row of surgery, training surgeons is by far the most important goal for the next few years. KEY WORDS: Feasibility, high variance, robotic surgery, systematic review Robotic surgery used to sound like science fiction, the same as putting a man on the moon. With that said, as a matter of fact, some of the greatest ad- vances in robotic surgery technology were inspired by NASA. Robotic surgery was first used in 1983 in Canada, developed by an orthopedic surgeon and his team; the robot was named the “Arthrobot.” Since then, surgical robots evolved and were used inmany fields of surgery from ophthalmology, through general surgery, urology, and gynecology. The “Arthrobot” was the first in a long line of surgical assisting robots, including some that handed surgical tools to the surgeon and others that performed surgery under the surgeon’s guidance or control. The next great step was in 1985. Kwoh and his associates performed a brain biopsy under CT guidance with the assistance of a robotic arm—PUMA560. 1 Robotic surgery evolved through PROBOT (the first prostate surgical robot), ROBODOC (the first hip replace- ment surgical robot), and on to ZEUS—the da Vinci robot predecessor. ZEUS was the first surgical robot to perform gynecological surgery when it was used in 1997 to reconnect fallopian tubes in state-of-the-art robotic surgery in Cleveland, Ohio, USA. By the end of the twentieth century, robotic surgery was used in thoracic surgeries for heart bypasses. In the beginning of the twenty-first century, the first ever successful telerobotic procedure, a chole- cystectomy, was performed utilizing the ZEUS robot. Surgery was performed by a surgeon based in New York on a patient operated on in France. 2 The idea of telerobotics was even pitched to the Penta- gon as a safe option that could enable surgical staff to treat injured soldiers on the battlefield without jeopardizing any more men. The project was named Mobile Advanced Surgical Hospital (MASH). Though never implemented at the time, the MASH system fueled the momentum for daily clinical implementation in the hospital environment. 3 The company that developed the ZEUS robot was purchased by Intuitive Surgical, Inc., and after years of attempts to upgrade the system they brought out the da Vinci surgical robot. In 2005, the US Food and Drug Administration (FDA) approved the use of the da Vinci robotic system in gynecological surgery. The year 2009 saw the publication of a large multi-institutional study on the use of the da Vinci robotic surgical system in gynecologic oncology, including learning curves for current and new users as a method to assess acquisition of their skills using the device. Robotic surgery has evolved immensely over the last decade. Hundreds of studies have been pub- lished in the last 8 years, since the afore-mentioned study, in this field, ranging from theoretical to practical aspects. A recent report by Intuitive Surgical, Inc. pointed out that during 2007–2013 the number of robotic surgical systems more than doubled in the US (from 800 to 2001) and Europe (from 200 to 443). The same report stated that 1.5 million robotic surgeries had been performed until 2013 in the world. The da Vinci System was introduced in Israel in 2009. Currently, about 55% of all radical prosta- tectomies in Israel are robotic surgeries. At the time of writing, six robotic systems have been installed in six medical centers around Israel. Surgeons at the Rambam Health Care Campus began robotic surgeries in November 2010 and in the field of gynecology in April 2011. Robotic surgery in gynecology covers a broad spectrum of uses and is growing fast. The da Vinci Surgical System is used for benign indications such as treatment for fibroids, abnormal periods, endo- metriosis, pelvic prolapse, and ovarian growths, or for malignancies such as endometrial cancer, cer- vical cancer, or ovarian cancer. The robotic system may assist the gynecological surgeon in performing hysterectomies, salpingectomies, oophorectomies, myomectomies, and lymph node biopsies. Thus, abdominal surgery may become obsolete in the future—as we said, science fiction. Quite a few medical centers around the world have extensively | The Surgical Technolog st | DECEMBER 2019 568