Robotic Technology Overcomes Previous Limitations
While this analysis did not include cases involving open radical hysterectomy and lymphadenectomy, we know from other series and reports that the number of resected lymph nodes increases with a laparoscopic approach, whether or not it is robotically performed.
In studies in our fellowship training program, moreover, we have found that fellows who have less experience with laparoscopic surgery than attendings achieved the same number of lymph node retrievals as the attendings through either conventional laparoscopic or robotic lymphadenectomy. Such ease and reproducibility portends well for the future of robotic technology in gynecologic oncology.
Some of the major advantages of robotic-assisted surgery are that it provides 3-D views, allows intuitive motions, and involves less operator fatigue. In addition, tremor filtration facilitates more precise movements. It entails a shorter learning curve than does conventional laparoscopy. Robotic-assisted surgery has also paved a pathway to telesurgery and telementoring. This may expand the availability of advanced minimally invasive surgeries throughout the globe.
Dr. Nezhat had no financial conflicts of interest to disclose.
Robotic-Assisted Lymphadenectomy
Despite the early, pioneering efforts of physicians such as Dr. Denis Querleu in France, as well as Dr. Joel Childers and our author, Dr. Farr R. Nezhat, in the United States, the acceptance of laparoscopic surgery by gynecologic oncologists has been lackluster at best. Lately, however, no area of our specialty has shown faster adaptation to minimally invasive surgery than has gynecologic oncology. In fact, secondary to the interest in laparoscopic oncologic procedures, the AAGL has recently created a gynecologic oncology specialty group. Due to his vast experience, Dr. Nezhat has been given a leadership role in this endeavor. It is this editor's belief that the utilization of robotics is the single factor that has created such a rapid movement within the gyne-oncology community to embrace laparoscopic surgery. The 3-D visualization, combined with the seven degrees of motion of robotic instrumentation, has enabled the gynecologic oncologist to work precisely and efficiently. Despite his vast experience in laparoscopic surgery, our guest author was an early convert to robotic-assisted surgery.
Dr. Nezhat is the director of minimally invasive surgery and gynecologic robotics, as well as chief of the gynecologic robotic, minimally invasive surgery fellowship, in the division of gynecologic oncology at St. Luke's-Roosevelt Hospital Center, New York. He has written more than 100 articles in peer-reviewed journals, many of which involve laparoscopic surgery. Dr. Nezhat is truly one of the thought leaders of our specialty. It is an honor to have him write this current column of the Master Class in gynecologic surgery.
