Evolving technologies in robotic surgery for minimally invasive treatment of gynecologic cancers

Abstract

Since the introduction of robotic technology, there have been significant changes to the field of gynecologic oncology. The number of minimally invasive procedures has drastically increased, with robotic procedures rising remarkably. With recent evidence suggesting that minimally invasive techniques should be the standard of care for early endometrial and cervical cancers, the push for new technology and advancements has continued. Several emerging robotic technologies have significant potential in the field of gynecologic oncology. The single-site robotic platform enables robotic surgery through a single incision; the Firefly camera detects the fluorescent dye indocyanine green, which may improve sensitivity in sentinel lymph node biopsy; and a robotic vessel-sealing device and stapler will continue to improve efficiency of the robotic surgeon.

Keywords::

• endoscopic stapler
• EndoWrist one
• fluorescence imaging
• indocyanine green
• laparoendoscopic single site
• minimally invasive techniques
• robotic surgery
• sentinel node dissection

Financial & competing interests disclosure

PF Escobar is a consultant for Intuitive Surgical and Covidien. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Recent evidence suggests that minimally invasive techniques should be the standard of care for many early gynecologic malignancies; therefore it is important to critically evaluate emerging technologies that continue to expand and improve our ability to provide minimally invasive surgery.

• • Laparoendoscopic single-site surgery has been developed in an attempt to further reduce and minimize conventional laparoscopy. However, the concept of multiple instruments and optics operating through a single incision has given rise to specific challenges and unique ergonomic problems not previously encountered with conventional laparoscopy.

• • Robotic technology may overcome some of the unique challenges and ergonomic problems of laparoendoscopic single-site surgery.

• • The single-site robotic platform was very recently US FDA approved for gynecologic procedures.

• • Literature from general surgery as well as preclinical data in the gynecologic literature suggest that single-site robotic surgery is feasible, safe and has potential applications in gynecologic surgery, both benign and malignant.

• • Sentinel lymph node biopsy rather than complete lymphadenectomy for treatment of endometrial and cervical cancers is an active area of current study and research.

• • Indocyanine green is a fluorescent dye which may further improve sensitivity and decrease the false-negative rate of sentinel lymph node biopsy for gynecologic malignancies.

• • Novel optics for both laparoscopy and robotics which allow visualization of indocyanine green can now be utilized to further investigate these promising techniques.

• • New instruments for the robotic platform, including the EndoWrist One Vessel Sealer and the robotic stapling device, will likely help to expand the types of procedures that can be performed using the da Vinci robot as well as increase efficiency for the robotic surgeon.

• • As robotic platforms and instruments continue to evolve, robust prospective evidence will be necessary to support the applications of these emerging and progressive technologies.

Notes