Academic Article,December

Atthapon Jaishuen, M.D., Khemanat Khemworapong, M.D.
Faculty of Medicine Siriraj Hospital, Mahidol University

Robotic-Assisted Laparoscopic Surgery in Gynecologic Cancer: Development and Clinical Benefits

         Gynecologic cancer is a major health problem that affects women worldwide. Surgery remains one of the main treatment methods for gynecologic cancers, and advancements in surgical technology have played a significant role in enhancing the efficiency and safety of treatments. Traditional open abdominal surgery, while still used for some types of cancer, has notable limitations such as risks from large incisions, slow recovery, and potential complications such as infections, postoperative pain, and visible scarring.

      To overcome these limitations, laparoscopic surgery has been utilized in the treatment of gynecologic cancers for several years, reducing incision size, lowering the risk of complications, and accelerating patient recovery. However, laparoscopic surgery still has limitations, including the need for highly skilled surgeons, restricted tool movement, and challenges in accessing lymph nodes. As a result, robotic surgery was developed to address these limitations by using robotic systems to control surgical instruments via a console. This enhances precision, allows for greater range of motion in multiple directions, and provides a clear three-dimensional view of internal organs, improving access to difficult-to-reach areas such as lymph nodes.

Advantages of Robotic Surgery in Gynecologic Cancer Patients:

1. Reduced Blood Loss: Robotic surgery allows for more precise cutting and ligating of blood vessels, which can significantly reduce blood loss compared to traditional surgery.

2. Faster Recovery: Patients undergoing robotic surgery often experience quicker recovery due to smaller incisions and minimal port movement.

3. Shorter Hospital Stay: Patients typically have a shorter hospital stay compared to open abdominal surgery, due to less pain and faster recovery.

4. Access to Complex Organs: Robotic systems can access hard-to-reach organs more effectively, such as during the removal of lymph nodes, which are often sites of cancer spread.

5. Three-Dimensional Imaging: The use of 3D imaging helps surgeons visualize internal organs with greater clarity, increasing surgical precision.

      Currently, this technology is used across various organ systems, including urology, gastrointestinal surgery, and gynecologic surgery. Robotic-assisted laparoscopic surgery for gynecologic cancer has been widely applied since 2005. A systematic review of the literature on robotic surgery for endometrial cancer found that it is highly effective, particularly in reducing blood loss, promoting faster recovery, shortening hospital stays, and improving the ability to remove difficult lesions, such as those in lymph nodes.

      In Thailand, robotic surgery for cancer began with prostate cancer patients in 2007 and later expanded to gynecologic cancer patients, particularly for endometrial cancer surgery. Hospitals such as Rajvithi Hospital, Songklanagarind Hospital, and Siriraj Hospital have incorporated this technology into their gynecologic oncology treatments. However, the high cost of robotic surgery remains a significant limitation. To address this, Siriraj Hospital launched the “Her Royal Highness Princess Maha Chakri Sirindhorn’s 70th Birthday Commemoration Project for High-Cost, High-Technology Medical Treatments for Underserved Patients,” which includes the use of robotic surgery. This project is scheduled to run from 2024 to 2026.

Conclusion

Robotic surgery for gynecologic cancer is an important innovation that improves precision, reduces complication risks, and accelerates recovery. The decision to use this technique should be based on the type of cancer, stage of the disease, the patient’s overall health, and the expertise of the medical team. Careful consultation and treatment planning with patients will help ensure the most effective treatment outcomes.

References

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2. Lenihan JP, Jr. How to set up a robotic-assisted laparoscopic surgery center and training of staff. Best Pract Res Clin Obstet Gynaecol. 2017;45:19-31.

3. Yim GW, Kim YT. Robotic surgery in gynecologic cancer. Curr Opin Obstet Gynecol. 2012;24(1):14-23.

4. Gala RB, Margulies R, Steinberg A, Murphy M, Lukban J, Jeppson P, et al. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol. 2014;21(3):353-61.