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Early experience of gynecologic robotic surgery in a tertiary government hospital

Efren J. Domingo, MD, PhD, FPOGS, FSGOP and Patrick Jose D. Padilla, MD
Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines-Manila

Background: Robotic surgery is a form of minimally invasive surgery wherein the surgeon controls the camera and instruments in a console, remote from the operating room table. Currently, the system in place is the da Vinci Surgical System which was approved by the United States Food and Drug Administration in 2000 for laparoscopic surgery. Since its approval in 2005 for Gynecologic procedures, the da Vinci Surgical System has been used for hysterectomies, lymph node dissections, sacrocolpopexies, myomectomies, and cerclage.

Objective: This paper presents the initial seven cases of benign gynecologic diseases operated on utilizing the da Vinci Surgical System in our institution – six hysterectomies and one myomectomy.

Methodology: Seven gynecologic surgeries that utilized the da Vinci Surgical System in 2019 until the first quarter of the year 2020 were done. Medical records of the seven patients were reviewed.

Results: The average docking time was 38 minutes (range: 25 – 65 minutes) and the average console time was 227 minutes (range: 175 – 345 minutes). The average blood loss was 576 cc (range: 80 – 1200 cc). No cases converted to an abdominal laparotomy and no morbidities were reported. While two cases underwent blood transfusion intraoperatively, all cases were stable post-operatively and were for discharge after two days. On follow-up, all patients were stable with an unremarkable clinical course.

Conclusion: Our initial experience demonstrates that robotic surgery appears as a viable alternative to traditional approaches. As more cases are to be done in the future, fine-tuning of the logistical set-up and surgical skills are expected, as well as venturing into other gynecologic diseases such as malignancies. Further research must be
conducted on various aspects of robotic surgery, such as but not limited to outcome comparison with traditional and other laparoscopic approaches, long term outcomes, patient safety, and patient experience and preference, among others.