Robotic assisted laparoscopic surgery in gynaecological cancer

Abstract

Laparoscopic surgery has been widely used in the management of gynaecological cancers. The main advantages are faster patient recovery and shorter hospital stay. For the patient, less pain and smaller wound over conventional laparotomy are other benefits. The main disadvantages are the long learning curve and cost of the instruments. With the robotic assisted laparoscopic surgery, it shorten the learning curve with the 30 vision, more agile instruments; more precis motions without tremor and more ergonomic for surgeon. The main disadvantages of robots are the cost, time in preparation of the robots and the decrease in flexibility of positioning once the robots is set up. The lack of tactile sensation is not a major issue. With side docking instead of docking from the end of table, pelvic assistance has ample space at the end of the bed and make vaginal manipulation or if necessary vaginal operation much easier. Robotic assisted laparoscopic surgery has been used in performing total hysterectomy and bilateral salpingooophorectomy, pelvic and para-aortic lymphadenectomy in the management of endometrial cancer; radical hysterectomy +/- bilateral salpingooophorectomy, pelvic lymphadenectomy in the management of cervical cancer and staging operation including omentectomy and appendectomy for ovarian cancer. More and more studies confirmed the shorter hospital stay, less blood loss, no increase in morbidity or even less morbidity though longer operative time when compared to laparotomy. There was no difference in survival though there was no long term follow-up data yet. Port-site metastasis is uncommon. To conclude, robotic assisted laparoscopic surgery should be developed in gynaecology oncology. Large randomized control trial is awaited to confirm that the survival outcome is not affected.