Obstetrics and Gynecology

Robotic surgery is the most advanced method for performing surgical procedures. It delivers excellent surgical outcomes without compromising patient safety, while reducing complications compared to traditional open surgery.

Millions of patients worldwide who have undergone robotic-assisted procedures report faster recovery and a quicker return to their daily activities.

How is a robotic procedure performed?

Robotic procedures are performed through small skin incisions (approximately 8 mm), through which the robotic instruments and camera are inserted.

The system is fully controlled by the surgeon via advanced robotic controls, translating hand movements into highly precise, refined movements of the surgical instruments.

Why is Robotic Surgery widely used in Gynecology?

In the United States, where robotic surgery has been used since the early 2000s, gynecological procedures represent the majority of robotic operations.

This demonstrates that even in such a sensitive field, robotic surgery has become the modern evolution of laparoscopy.

The use of robotic surgery is continuously expanding in the field of gynecology. It encompasses procedures ranging from the management of benign tumors, such as fibroids and dysfunctional uterine bleeding, to complex oncological surgeries for the treatment of gynecological cancer.

Robotic Surgery vs Open Surgery and Conventional Laparoscopy

The advantages of robotic surgery compared to open procedures and conventional laparoscopy are reflected in key clinical indicators, including:

• length of hospital stay
• blood loss
• the need for intraoperative conversion to open surgery due to inability to complete the procedure laparoscopically
• the number of days required for the patient to return to work
• the size of the surgical specimen
• whether the patient has undergone previous abdominal surgeries (surgical history)

In all of the above, robot-assisted gynecological surgery has been shown to provide:

• one-day hospitalization
• reduced blood loss
• fewer intraoperative complications, even in complex procedures (increased adhesions due to previous surgeries, large fibroids, surgical specimens >250 g), lower complication rates within the first 30 days after surgery, and lower rates of hospital readmission compared to open surgery and conventional laparoscopy
• full return to social activities within 2 weeks and, in the majority of cases, uninterrupted return to work within 4 weeks

In addition, technological advancements have introduced new surgical standards. The integrated 3D HD imaging system enhances the surgeon’s visual perception and allows for improved detection of endometriosis lesions, both superficial and deep.

Robotic Surgery and Reproductive Health

Myomectomy and the surgical management of endometriosis constitute the majority of procedures required to improve successful pregnancy rates.

The stability of the robotic system in suturing and reconstructing anatomical structures offers significant advantages in the protection and preservation of reproductive anatomy in women of reproductive age.

Robotic surgery enables highly accurate and detailed reconstruction of anatomical structures, while resulting in significantly fewer adhesions.

For this reason, it represents an ideal approach for the treatment of endometriosis, as well as for fertility-enhancing procedures in subfertile couples.

Management of Gynecological Cancer

In gynecological oncology, robotic surgery has fundamentally changed the surgical management of the disease, particularly in endometrial and cervical cancer.

Since the introduction of robotic systems into clinical practice and their approval by the FDA in 2005, there has been a major shift toward robotic surgery due to its advantages over open approaches and conventional laparoscopic techniques.

These procedures, in the majority of cases, include total hysterectomy with removal of the adnexa, as well as extensive pelvic lymphadenectomy (removal of lymph nodes from the pelvis).

Due to the complexity of oncological cases, often involving elderly patients with comorbidities, such as cardiac and respiratory conditions, and frequently a history of multiple prior surgeries, including cesarean sections and myomectomies, physicians worldwide rely on robotic surgery to provide high-quality care.

These services are associated with the removal of a greater number of lymph nodes, as well as fewer postoperative complications, such as wound infections, respiratory infections, systemic infections, and injuries to anatomical structures adjacent to the internal gynecological organs, compared to conventional laparoscopy and open surgery.

The improved, while oncologically safe, outcome has established robotic surgery worldwide as the procedure of choice for endometrial and cervical cancer. International guidelines recommend that, whenever feasible, a minimally invasive approach should be followed in the management of endometrial cancer, confirming the superiority and safety of this technique.