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Master Class in Gynecologic Surgery: Advancements in Robotic Surgery (featuring Dr. Thomas Payne)

Robotic-assisted surgery has been both celebrated as “revolutionary” and defamed as a “crutch.” No matter where your loyalties lie in this debate, what is not debatable is the dramatic increase in minimally invasive surgery (MIS) rates for hysterectomy since robotic-assisted surgery was approved for gynecology in 2005. Rates vary across samples and sources, but according to 2011 data from Solucient and 2010 data from the Agency for Healthcare Research and Quality, approximately 27% of hysterectomies are performed with the robot, 26% with standard laparoscopy, and 12% vaginally.

Read the full article in Ob. Gyn News

The Ob. Gyn News’ Master Class in Gynecologic Surgery is hosted by AAGL SurgeryU, and is edited by Dr. Charles E. Miller, a past president of the AAGL, and a long standing faculty member of SurgeryU.

In this cooperative effort, Ob. Gyn. News and AAGL SurgeryU will be working very closely together to promote education in minimally invasive gynecologic surgery. This collaboration will allow viewers the opportunity to examine state-of-the-art procedures from true experts in our field. Not only will these videos be accompanied with a summary abstract, but the complete article pertaining to the surgery can be view via a link to Ob. Gyn. News. Again, thank you for your interest and please enjoy this exciting new venture.

APRIL 2013: Advances in Robotic Surgery

MULTI-SITE PROCEDURE:


Master Course: Koh Multi-Site Robotically-Assisted Laparoscopy

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The Koh technique is utilized with multiple ports on the robotic platform. A uterine manipulator with a pneumo-occluder balloon is placed to initiate procedure. Ports are arranged 8-10 cm apart in an arch configuration. The first assistant skill set to facilitate the procedure is emphasized. Bipolar and monopolar instruments are used to release the lateral attachments and for creation of the bladder flap. Anterior and posterior colpotomies are created early, avoiding the uterine arteries. The uterine arteries are taken down at the end of the procedure from the lateral view. Aggressive cephalad pressure on the uterine manipulator is maintained throughout the case.

 

DUAL-SITE PROCEDURE:


Master Course: Dual-Site Robotically-Assisted Laparoscopy

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Instrument selection for successful completion of 2-port robotic assisted hysterectomy technique is reviewed, and port placement and docking philosophy are demonstrated. Use of the endowrist 1 articulating seal and cut device is used to take down lateral attachments and round ligaments. The 2-mm portless alligator grasper is utilized by the first assistant to provide retraction and presentation of tissue. The anterior and posterior colpotomies are performed prior to sealing and cutting the uterine arteries. The collaborative effort between the surgeon and first assist for cuff closure is demonstrated.

 

SINGLE-SITE PROCEDURE:


Master Course: Single-Site Robotically Assisted Laparoscopy

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Instrument selection for successful completion of a single-site robotic-assisted hysterectomy is reviewed. Bipolar and monopolar instruments are used to complete the procedure. The lateral attachments are released, and the bladder flap is created and developed followed by an early anterior and posterior colpotomy. The uterine arteries are then secured and transected. The vaginal cuff closure is facilitated using a Keith needle.

 

VAGINAL MORCELLATION PROCEDURE:


Master Course: Vaginal Morcellation

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Instruments needed for successful traditional vaginal morcellation are reviewed. Morcellation techniques such as coring, bivalving, myomectomy and wedging are briefly reviewed. Cost savings over endoscopic morcellation are noted.

 


Filed under "Master Course in Gynecologic Surgery".

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