Arian Sara E, Munoz Jessian L, Kim Suejin, Falcone Tommaso
Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
Robot Surg. 2017 Jan 23;4:7-18. doi: 10.2147/RSRR.S102743. eCollection 2017.
Robotic-assisted surgery has seen a rapid development and integration in the field of gynecology. Since the approval of the use of robot for gynecological surgery and considering its several advantages over conventional laparoscopy, it has been widely incorporated especially in the field of reproductive surgery. Uterine fibroids are the most common benign tumors of the female reproductive tract. Many reproductive-aged women with this condition demand uterine-sparing surgery to preserve their fertility. Myomectomy, the surgical excision of uterine fibroids, remains the only surgical management option for fibroids that entails preservation of fertility. In this review, we focus on the role of robotic-assisted laparoscopic myomectomy and its current status, in comparison with other alternative approaches for myomectomy, including open, hysteroscopic, and traditional laparoscopic techniques. Several different surgical techniques have been demonstrated for robotic myomectomy. This review endeavors to share and describe our surgical experience of using the standard laparoscopic equipment for robotic-assisted myomectomy, together with the da Vinci Robot system. For the ideal surgical candidate, robotic-assisted myomectomy is a safe minimally invasive surgical procedure that can be offered as an alternative to open surgery. The advantages of using the robot system compared to open myomectomy include a shorter length of hospital stay, less postoperative pain and analgesic use, faster return to normal activities, more rapid return of the bowel function, and enhanced cosmetic results due to smaller skin incision sizes. Some of the disadvantages of this technique include high costs of the robotic surgical system and equipment, the steep learning curve of this novel system, and prolonged operative and anesthesia times. Robotic technology is a novel and innovative minimally invasive approach with demonstrated feasibility in gynecological and reproductive surgery. This technology is expected to take the lead in gynecological surgery in the upcoming decade.
机器人辅助手术在妇科领域得到了快速发展和广泛应用。自机器人用于妇科手术获得批准以来，鉴于其相对于传统腹腔镜手术具有诸多优势，它已被广泛应用，尤其是在生殖外科领域。子宫肌瘤是女性生殖道最常见的良性肿瘤。许多患有这种疾病的育龄妇女要求进行保留子宫的手术以保留生育能力。子宫肌瘤切除术，即切除子宫肌瘤的手术，仍然是保留生育能力的子宫肌瘤唯一的手术治疗选择。在本综述中，我们重点关注机器人辅助腹腔镜子宫肌瘤切除术的作用及其现状，并与其他替代的子宫肌瘤切除方法进行比较，包括开放手术、宫腔镜手术和传统腹腔镜技术。已经展示了几种不同的机器人子宫肌瘤切除手术技术。本综述致力于分享和描述我们使用标准腹腔镜设备及达芬奇机器人系统进行机器人辅助子宫肌瘤切除术的手术经验。对于理想的手术候选人，机器人辅助子宫肌瘤切除术是一种安全的微创手术，可以作为开放手术的替代方案。与开放子宫肌瘤切除术相比，使用机器人系统的优势包括住院时间更短、术后疼痛和镇痛药使用更少、更快恢复正常活动、肠道功能恢复更快以及由于皮肤切口更小而美容效果更好。该技术的一些缺点包括机器人手术系统和设备成本高昂、这种新型系统的学习曲线陡峭以及手术和麻醉时间延长。机器人技术是一种新颖且创新的微创方法，已在妇科和生殖外科手术中证明了其可行性。预计该技术将在未来十年引领妇科手术发展。
