Robotic omentectomy in gynecologic oncology: surgical anatomy, indications, and a technical approach.

An omentectomy is a standard component care of gynecological cancers, particularly for surgical staging and treatment for malignant ovarian neoplasms, borderline tumors, fallopian tube cancers, primary peritoneal cancers as well as certain histological subtypes of endometrial cancer. Traditionally, an omentectomy is performed by an open laparotomy approach, however, use of a robotic approach has gained popularity and has been proven to be both safe and effective. In spite of the advantages of robotic surgery compared to laparotomy, the inherent technical challenges of a robotic omentectomy may limit its uptake.

Initial surgical management of bulky malignant type II tumors of the endometrium by a robotic approach.

Type II uterine tumors often present with very large, necrotic tumor burden in the uterus that leads to dilation and effacement of the cervix. In patients with this presentation, conventional hysterectomy poses a much greater challenge as the ureters are composed of the mass of the tumor and are at an increased risk for injury. Given this surgical challenge, many of these patients may begin with neoadjuvant chemo-radiation.

Robotic surgery for staging of serous papillary and clear cell carcinoma of the endometrium.

Background: The feasibility of robotic staging for high-risk endometrial cancer is unclear.

Methods: Retrospective review of papillary serous and clear cell endometrial cancer open staging (OS) and robotic staging (RS) cases (2009-2011) by two gynaecological oncologists.

Results: There were 15 OS and 17 RS cases (no conversions).

Perioperative and clinical outcomes in the management of epithelial ovarian cancer using a robotic or abdominal approach.

Objective: To evaluate the feasibility and efficacy of robotic-assisted management of epithelial ovarian cancer.

Methods: Retrospective review of robotic-assisted or abdominal ovarian cancer cases presenting with pelvic mass, initial staging, or debulking after neoadjuvant chemotherapy performed by a single surgeon (2008-2012). Patient characteristics and outcomes were compared using chi-squared or Student's t-tests.

Posterior colpotomy: a successful retrieval route for pelvic masses following robot-assisted laparoscopic surgery.

We report a technique of transvaginal extraction of pelvic masses or larger specimens removed during robot-assisted laparoscopic surgery in order to avoid larger port incisions and postoperatively reduce pain. Fifty women underwent a transvaginal incision to remove large pelvic masses after robot-assisted laparoscopic hysterectomies. Posterior colpotomies were performed with bagged specimens delivered into the vagina, extracted, and then closed robotically with a running suture.

Surgical technique enhances the efficiency of robotic hysterectomy.

Background: The purpose of this study was to evaluate the benefits and morbidity associated with a novel technique for a hysterectomy designed specifically for a robotic-assisted laparoscopic procedure. Recent studies have compared robotic-assisted laparoscopic hysterectomy vs. open hysterectomy.

Comparison of a novel surgical approach for radical hysterectomy: robotic assistance versus open surgery.

To report the learning curve and perioperative outcomes for robotic radical hysterectomy using a unilateral surgical approach transferred directly from one surgeon's open radical hysterectomy experience, thirty-two consecutive robotic radical hysterectomy cases (10/2006-1/2009) were contrasted to a cohort of 20 consecutive open radical hysterectomies (2/2005-2/2008). Perioperative characteristics compared included operative time, number of nodes, estimated blood loss, length of hospital stay, and complications. Robotic operative times were significantly longer than for open (122.