Robotic-assisted surgery in gynecologic oncology

Robotic-assisted surgery is the most dynamic development in gynecologic oncology and represents the latest step in technical development. Robotic surgery is feasible as a standardized procedure in cervical cancer, endometrial cancer and radical systematic lymphonodectomy. Experimental approaches, such as trachelectomy to preserve fertility or mesometrial tumor resection along the embryonic structures, are finding their way into robotic-assisted surgery; however, minimally invasive treatment of borderline tumors and early ovarian cancer is still controversial. Complex operations, such as exenteration or surgery covering multiple abdominal quadrants, are increasingly being performed with the DaVinci system. The expansion to the DaVinci Xi module has led to a multivariable application. All four trocars have the same diameter, allowing the camera to be changed to any trocar when necessary. In addition, the altered geometry of the patient cart allows four-quadrant surgery. The reduced size of all components and the concomitant increase in the length of instruments allow a higher flexibility in all types of surgery. The table motion allows a change in the degree of Trendelenburg positioning without docking off the system. The second console and the simulator tool lead to new dimensions in surgical education. Cooperation over long distances and interdisciplinary teamwork are possible by telemetry. The largest disadvantages are still the high purchase and maintenance costs. Medical staff has to undergo extensive training before using the new technology to perform safe procedures.