New Strategy for Uterine Parametrium Tissue Dissection Using Robotically Enhanced Surgical Anatomy for Robot-assisted Hysterectomy.

The concept of robotically enhanced surgical anatomy (RESA) has recently been proposed. We concur with the concept of RESA and have been pursuing surgical techniques that benefit from the attribute of robot-assisted surgery. We evaluated RESA and its significance for organ dissection and cavity development in total robot-assisted hysterectomy. Pelvic cavity development and organ dissection can be achieved naturally by applying the appropriate counter traction and carefully dissecting the areolar connective tissue identified by RESA. For uterine parametrial tissue, which is based on the bunching technique, the uterine vessels, including the deep uterine vein, can be readily isolated and ligated through RESA. In some cases, the vaginal vessels can also be isolated and bunching technique can be minimized. Currently, we are striving to perform robotic surgeries that maximize the use of RESA. The following video shows some of the robotic-assisted surgeries that we perform in our department.