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Understanding the spectrum of multiport and single-site robotics for hysterectomy

We present this video with the objective of demonstrating a hysterectomy performed using the robotic single-site approach in juxtaposition with a robotic multiport hysterectomy. In the video, and briefly here, we review the benefits, disadvantages, and challenges of robotic single-site hysterectomy. 

The advantages of single-site robotic hysterectomy include:

  • possible improved aesthetics for the patient
  • allowance for surgeon independence while minimizing the need for a bedside assistant
  • automatic reassignment of the robotic arm controls
  • circumvention of certain limitations seen in laparoscopic single-site procedures.

The disadvantages of single-site robotic hysterectomy include:

  • instrumentation is nonwristed and less robust than that of multiport instrumentation
  • decreased degrees of freedom
  • longer suturing time
  • restricted assistant port use
  • decreased applicability to a wide range of procedures as the surgical approach is limited to less complex and smaller pathology.

Related articles:
The robot is broadly accessible less than 10 years after its introduction to gynecologic surgery. Janelle Yates (News for your Practice; December 2013)
The robot is gaining ground in gynecologic surgery. Should you be using it? Arnold P. Advincula MD; Cheryl B. Iglesia MD; Rosanne M. Kho MD; Jamal Mourad, DO; Marie Fidela R. Paraiso, MD; Jason D. Wright, MD (Roundtable; April 2013)
Identify your learning curve for robotic hysterectomy. Joshua L Woelk, MD, MS, and John B. Gebhart, MD, MS (Guest Editorial; April 2013)

In general, each step of the single-port procedure has been found to be equivalent in time to a multiport approach to robotic-assisted hysterectomy—except for the step of vaginal cuff closure. Since the initial experience, aside from overcoming the learning curve of a new surgical approach, various techniques have been modified in order to surmount this challenge, such as closing the vaginal cuff vertically, using a cutting needle versus a tapered needle, addition of a “plus one” wristed multiport robotic arm, or replacing the single-site robotic needle driver with a multiport 5-mm needle driver.

Nevertheless, widespread adoption of single-site robotic gynecologic surgery still requires further technological improvements, and further research and experience is needed to determine its role, benefits, and applications in gynecologic surgery.

--Dr. Arnold Advincula, AAGL 2014 Scientific Program Chair

WE WANT TO HEAR FROM YOU!Share your thoughts on this article. Send your Letter to the Editor to: [email protected]

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Dr. Truong is Fellow in Minimally Invasive Gynecologic Surgery, Columbia University Medical Center, New York, New York. Dr. Advincula is Professor and Vice Chair, Women’s Health, and Chief, Gynecology, Department of Obstetrics and Gynecology, Columbia University Medical Center. Dr. Advincula also serves on the OBG Management Board of Editors.

Dr. Truong reports no financial disclosures relevant to this article. Dr. Advincula reports being a consultant to Blue Endo, Cooper Surgical, Intuitive Surgical, and Surgiquest and receiving royalties from Cooper Surgical.

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Arnold P. Advincula,Mireille D. Truong,video series,multiport and single-site robotics,hysterectomy,robotic arm controls,bedside assistant,robotic instruments,vaginal cuff closure,cutting needle,tapered needle,robotic gynecologic surgery,AAGL
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Dr. Truong is Fellow in Minimally Invasive Gynecologic Surgery, Columbia University Medical Center, New York, New York. Dr. Advincula is Professor and Vice Chair, Women’s Health, and Chief, Gynecology, Department of Obstetrics and Gynecology, Columbia University Medical Center. Dr. Advincula also serves on the OBG Management Board of Editors.

Dr. Truong reports no financial disclosures relevant to this article. Dr. Advincula reports being a consultant to Blue Endo, Cooper Surgical, Intuitive Surgical, and Surgiquest and receiving royalties from Cooper Surgical.

Author and Disclosure Information

Dr. Truong is Fellow in Minimally Invasive Gynecologic Surgery, Columbia University Medical Center, New York, New York. Dr. Advincula is Professor and Vice Chair, Women’s Health, and Chief, Gynecology, Department of Obstetrics and Gynecology, Columbia University Medical Center. Dr. Advincula also serves on the OBG Management Board of Editors.

Dr. Truong reports no financial disclosures relevant to this article. Dr. Advincula reports being a consultant to Blue Endo, Cooper Surgical, Intuitive Surgical, and Surgiquest and receiving royalties from Cooper Surgical.

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We present this video with the objective of demonstrating a hysterectomy performed using the robotic single-site approach in juxtaposition with a robotic multiport hysterectomy. In the video, and briefly here, we review the benefits, disadvantages, and challenges of robotic single-site hysterectomy. 

The advantages of single-site robotic hysterectomy include:

  • possible improved aesthetics for the patient
  • allowance for surgeon independence while minimizing the need for a bedside assistant
  • automatic reassignment of the robotic arm controls
  • circumvention of certain limitations seen in laparoscopic single-site procedures.

The disadvantages of single-site robotic hysterectomy include:

  • instrumentation is nonwristed and less robust than that of multiport instrumentation
  • decreased degrees of freedom
  • longer suturing time
  • restricted assistant port use
  • decreased applicability to a wide range of procedures as the surgical approach is limited to less complex and smaller pathology.

Related articles:
The robot is broadly accessible less than 10 years after its introduction to gynecologic surgery. Janelle Yates (News for your Practice; December 2013)
The robot is gaining ground in gynecologic surgery. Should you be using it? Arnold P. Advincula MD; Cheryl B. Iglesia MD; Rosanne M. Kho MD; Jamal Mourad, DO; Marie Fidela R. Paraiso, MD; Jason D. Wright, MD (Roundtable; April 2013)
Identify your learning curve for robotic hysterectomy. Joshua L Woelk, MD, MS, and John B. Gebhart, MD, MS (Guest Editorial; April 2013)

In general, each step of the single-port procedure has been found to be equivalent in time to a multiport approach to robotic-assisted hysterectomy—except for the step of vaginal cuff closure. Since the initial experience, aside from overcoming the learning curve of a new surgical approach, various techniques have been modified in order to surmount this challenge, such as closing the vaginal cuff vertically, using a cutting needle versus a tapered needle, addition of a “plus one” wristed multiport robotic arm, or replacing the single-site robotic needle driver with a multiport 5-mm needle driver.

Nevertheless, widespread adoption of single-site robotic gynecologic surgery still requires further technological improvements, and further research and experience is needed to determine its role, benefits, and applications in gynecologic surgery.

--Dr. Arnold Advincula, AAGL 2014 Scientific Program Chair

WE WANT TO HEAR FROM YOU!Share your thoughts on this article. Send your Letter to the Editor to: [email protected]

We present this video with the objective of demonstrating a hysterectomy performed using the robotic single-site approach in juxtaposition with a robotic multiport hysterectomy. In the video, and briefly here, we review the benefits, disadvantages, and challenges of robotic single-site hysterectomy. 

The advantages of single-site robotic hysterectomy include:

  • possible improved aesthetics for the patient
  • allowance for surgeon independence while minimizing the need for a bedside assistant
  • automatic reassignment of the robotic arm controls
  • circumvention of certain limitations seen in laparoscopic single-site procedures.

The disadvantages of single-site robotic hysterectomy include:

  • instrumentation is nonwristed and less robust than that of multiport instrumentation
  • decreased degrees of freedom
  • longer suturing time
  • restricted assistant port use
  • decreased applicability to a wide range of procedures as the surgical approach is limited to less complex and smaller pathology.

Related articles:
The robot is broadly accessible less than 10 years after its introduction to gynecologic surgery. Janelle Yates (News for your Practice; December 2013)
The robot is gaining ground in gynecologic surgery. Should you be using it? Arnold P. Advincula MD; Cheryl B. Iglesia MD; Rosanne M. Kho MD; Jamal Mourad, DO; Marie Fidela R. Paraiso, MD; Jason D. Wright, MD (Roundtable; April 2013)
Identify your learning curve for robotic hysterectomy. Joshua L Woelk, MD, MS, and John B. Gebhart, MD, MS (Guest Editorial; April 2013)

In general, each step of the single-port procedure has been found to be equivalent in time to a multiport approach to robotic-assisted hysterectomy—except for the step of vaginal cuff closure. Since the initial experience, aside from overcoming the learning curve of a new surgical approach, various techniques have been modified in order to surmount this challenge, such as closing the vaginal cuff vertically, using a cutting needle versus a tapered needle, addition of a “plus one” wristed multiport robotic arm, or replacing the single-site robotic needle driver with a multiport 5-mm needle driver.

Nevertheless, widespread adoption of single-site robotic gynecologic surgery still requires further technological improvements, and further research and experience is needed to determine its role, benefits, and applications in gynecologic surgery.

--Dr. Arnold Advincula, AAGL 2014 Scientific Program Chair

WE WANT TO HEAR FROM YOU!Share your thoughts on this article. Send your Letter to the Editor to: [email protected]

Issue
OBG Management - 26(8)
Issue
OBG Management - 26(8)
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53
Page Number
53
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Understanding the spectrum of multiport and single-site robotics for hysterectomy
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Understanding the spectrum of multiport and single-site robotics for hysterectomy
Legacy Keywords
Arnold P. Advincula,Mireille D. Truong,video series,multiport and single-site robotics,hysterectomy,robotic arm controls,bedside assistant,robotic instruments,vaginal cuff closure,cutting needle,tapered needle,robotic gynecologic surgery,AAGL
Legacy Keywords
Arnold P. Advincula,Mireille D. Truong,video series,multiport and single-site robotics,hysterectomy,robotic arm controls,bedside assistant,robotic instruments,vaginal cuff closure,cutting needle,tapered needle,robotic gynecologic surgery,AAGL
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