Arnold Advincula's Surgical Techniques

Understanding the spectrum of multiport and single-site robotics for hysterectomy

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This striking educational video kicks off an exclusive surgical tips and techniques series from Arnold Advincula, MD


We present this video with the objective of demonstrating a hysterectomy performed using the robotic single-site approach in juxtaposition with a robotic multiport hysterectomy. In the video, and briefly here, we review the benefits, disadvantages, and challenges of robotic single-site hysterectomy.

The advantages of single-site robotic hysterectomy include:

  • possible improved aesthetics for the patient
  • allowance for surgeon independence while minimizing the need for a bedside assistant
  • automatic reassignment of the robotic arm controls
  • circumvention of certain limitations seen in laparoscopic single-site procedures.

The disadvantages of single-site robotic hysterectomy include:

  • instrumentation is nonwristed and less robust than that of multiport instrumentation
  • decreased degrees of freedom
  • longer suturing time
  • restricted assistant port use
  • decreased applicability to a wide range of procedures as the surgical approach is limited to less complex and smaller pathology.

Related articles:
The robot is broadly accessible less than 10 years after its introduction to gynecologic surgery. Janelle Yates (News for your Practice; December 2013)
The robot is gaining ground in gynecologic surgery. Should you be using it? Arnold P. Advincula MD; Cheryl B. Iglesia MD; Rosanne M. Kho MD; Jamal Mourad, DO; Marie Fidela R. Paraiso, MD; Jason D. Wright, MD (Roundtable; April 2013)
Identify your learning curve for robotic hysterectomy. Joshua L Woelk, MD, MS, and John B. Gebhart, MD, MS (Guest Editorial; April 2013)

In general, each step of the single-port procedure has been found to be equivalent in time to a multiport approach to robotic-assisted hysterectomy—except for the step of vaginal cuff closure. Since the initial experience, aside from overcoming the learning curve of a new surgical approach, various techniques have been modified in order to surmount this challenge, such as closing the vaginal cuff vertically, using a cutting needle versus a tapered needle, addition of a “plus one” wristed multiport robotic arm, or replacing the single-site robotic needle driver with a multiport 5-mm needle driver.

Nevertheless, widespread adoption of single-site robotic gynecologic surgery still requires further technological improvements, and further research and experience is needed to determine its role, benefits, and applications in gynecologic surgery.

--Dr. Arnold Advincula, AAGL 2014 Scientific Program Chair

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