Robotic single-port hysterectomy, adnexectomy, and lymphadenectomy in endometrial cancer.

STUDY

OBJECTIVE

To report the feasibility of performing robotic single-port surgery including pelvic lymphadenectomy in endometrial cancer.

DESIGN

Canadian Task Force III.

PATIENT: A 49-year-old, multiparous patient diagnosed with well-differentiated Fédération Internationale de Gynécologie et d'Obstétrique stage I endometrioid adenocarcinoma.

SETTING

The patient underwent robotic single-port peritoneal washing, total hysterectomy, bilateral adnexectomy, and pelvic lymphadenectomy. The procedure was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single 2.5-cm umbilical incision. We used a 5-lumen port for single-site instruments, a 3-dimensional high-definition 8.5-mm endoscope, a 5-mm accessory port, and insufflation channel. Monopolar cautery and a bipolar Maryland dissector were used for lymphadenectomy. Vaginal cuff closure was performed using a needle driver and Maryland dissector with V-lock suture. Near the end of the surgery, the 5-mm assistant port was changed with a 10-mm-sized port. Then, a dissected lymph node in an endobag and a needle used in vaginal cuff closure were removed through the 10-mm port.

INTERVENTIONS: Total hysterectomy and bilateral adnexectomy with pelvic lymphadenectomy were performed using robotic single-site platform.

MEASUREMENTS AND MAIN

RESULTS

The total operative time was 206 minutes. The total vaginal cuff closure time was 22 minutes, and lymphadenectomy took 48 minutes. The estimated blood loss was 100 mL; no intraoperative and postoperative complications occurred. The total number of excised lymph nodes was 11.

CONCLUSION

Robotic single-port pelvic lymphadenectomy is feasible. Further studies should be performed to assess the benefits of this procedure.