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DA VINCI SI SYSTEM: A. SURGEON CONSOLE; B. ROBOTIC CART; C. VISION CART (C) 2009 INTUITIVE SUR- GICAL. Inc.
Source publication
Hysterectomy, which is one of the most common surgeries performed on women, dates back to ancient times. The history of hysterectomy comprises biographies of many humble men and the significant individual efforts that they made to fight the skepticism of the medical communities of their times. Many of the pioneers were ignored. Although there are a...
Contexts in source publication
Context 1
... robotic systems da Vinci S and da Vinci SI are equipped with a double optic, which gives the operator three-dimensional view of the operative field, and with adjustable magnification, enabling much improved vision of the pelvis 15 . This system was developed in the US as an attempt to allow telesurgery for wounded soldiers, and it consists of three components: the robotic cart with in- struments, the vision cart and the surgeon console ( Figure 2A, 2B, 2C) 21 . The surgeon sits away from the patient at ergonomically designed console which has a stereoscopic viewer, hand manipulators and foot pedals, that allow them to control the camera and robotic instruments within the patient (Figure 2A) 15 . ...
Context 2
... system was developed in the US as an attempt to allow telesurgery for wounded soldiers, and it consists of three components: the robotic cart with in- struments, the vision cart and the surgeon console ( Figure 2A, 2B, 2C) 21 . The surgeon sits away from the patient at ergonomically designed console which has a stereoscopic viewer, hand manipulators and foot pedals, that allow them to control the camera and robotic instruments within the patient (Figure 2A) 15 . The robotic cart has 3 or 4 tel- erobotic arms for controlling the camera and surgical in- struments ( Figure 2B). ...
Context 3
... surgeon sits away from the patient at ergonomically designed console which has a stereoscopic viewer, hand manipulators and foot pedals, that allow them to control the camera and robotic instruments within the patient (Figure 2A) 15 . The robotic cart has 3 or 4 tel- erobotic arms for controlling the camera and surgical in- struments ( Figure 2B). These instruments have a wrist- like mechanism, allowing the surgeon a full 7 degrees of freedom of motion, similar to the human wrist in conven- tional open surgery 15 . ...
Citations
... Depending on their size and location, they can be asymptomatic or can cause pelvic pain and pressure, abnormal uterine bleeding, dysmenorrhea, hypermenorrhea, dyspareunia, and infertility, with a 40%-60% indication for hysterectomy. 9,10 The International Federation of Gynecology and Obstetrics (FIGO) has been providing up-to-date information for clinicians on leiomyomas, which have been listed as one of the main reasons for abnormal uterine bleeding during the reproductive years in the FIGO classification system; there is also a subclassification system for leiomyomas according to their locations. 11,12 Meanwhile, another team is working on a toolbox supporting clinicians to reach and manage patients with leiomyomas. ...
... In more recent times, MI procedures such as classic laparoscopy and robotic surgery have been established. While the first conventional total laparoscopic hysterectomy was performed by Harry Reich in 1988 [6], the DaVinci surgical system (Intuitive Surgical Inc., Sunnyvale, California, USA) was approved by the United States Food and Drugs Administration (FDA) for gynecologic surgery in 2005. Since then, the robotic technique has gained popularity among gynecologic surgeons in developed countries, leading to a decrease in the use of conventional laparoscopy [7]. ...
Introduction
Minimally invasive (MI) surgery has long been established as a standard for hysterectomy in benign conditions. Robotic surgery is generally seen as equivalent to conventional laparoscopy in terms of patient outcome. However, robotics might facilitate an MI approach even in complex patients, rendering laparotomy unnecessary for almost all patients.
Materials and methods
We identified 1939 patients who underwent hysterectomy for benign conditions between 2002 and 2020 at the University Hospital of Essen. Peri- and postoperative data as well as patient characteristics were collected retrospectively.
Results
Robotic surgery, implemented at our institution in 2010, was the most common approach ( n = 771; 39.8%). 60.2% of all hysterectomies (1168/1938) were performed using MI techniques. However, there was a significant shift in the methods used for hysterectomy over time. While in 2002 51.4% of all hysterectomies were performed via an open abdominal approach, this percentage dropped to 1.4% in the year 2020. Accordingly, the use of MI approaches increased from 18.9% in 2002 to 98.6% in 2020. The introduction of robotic surgery in 2010 marked a significant shift towards more MI procedures. MI surgery resulted in shorter hospital stay and less postoperative complications compared to laparotomy.
On a special note, our cohort includes the largest uterus myomatous uterus in the scientific literature with a specimen weight of 54.8 kg.
Conclusion
Our data support the hypothesis that the implementation of robotic surgery leads to an improved capability to perform MI surgery and avoid laparotomy in almost all patients. The known benefits of MI surgery could be confirmed.
... There is very scant satisfactory historical scholarship on the most common gynaecological surgery-hysterectomy-with most existing attempts to historicise it being conducted by gynaecologists themselves, rather than by scholars trained in methods of either critical or historical inquiry (Köninger and Kimmig 2011;Sutton 2007;Sutton 2018;Bauer et al. 2018;García and Miguel 2019;Mettler et al. 2013;Damewood 1992;Dursun, Gultekin, and Ayhan 2011;Sparić et al. 2011). Such surveys proposed by medical clinicians have generally sought to demonstrate the ancient origins of the practice of removing the uterus and pay homage to the early innovators of surgical technique. ...
... Such surveys proposed by medical clinicians have generally sought to demonstrate the ancient origins of the practice of removing the uterus and pay homage to the early innovators of surgical technique. Such histories, claiming to be comprehensive, have focused merely on the celebration of technical developments advanced by male surgeons in Western countries (Sutton 2007;Sutton 2018;Chamberlain 2007;Speert 1958;Speert 1980;Graham 1951;Kerr, Johnstone, and Phillips 1954;Damewood 1992;Sparić et al. 2011;Baskett 2003). They have suffered from an insufficient awareness of the incommensurability of past and present medical contexts and practices, and from an almost exclusive concentration on English-language sources. ...
This interdisciplinary historical paper focuses on the past and current state of diverse forms of surgical hysterectomy as a global phenomenon relating to population control and sterilisation. It is a paper grounded in historical inquiry but is unconventional relative to the norms of historical scholarship both in its wide geographical scope informed by the methodologies of global and intercultural history, in its critique of current clinical practices informed by recent feminist, race, biopolitical and disability studies, and by its engagement with scholarship in health sociology and medical anthropology which has focused on questions of gender and healthcare inequalities. The first part of the paper surveys existing medical, social-scientific and humanistic research on the racial, class, disability and caste inequalities which have emerged in the recent global proliferation of hysterectomy; the second part of the paper is about the diverse global rationales underlying radical gynaecological surgeries as a form of sterilisation throughout the long twentieth century. Radical gynaecological surgeries have been promoted for several different purposes throughout their history and, of course, are sometimes therapeutically necessary. However, they have often disproportionately impacted the most disadvantaged groups in several different global societies and have frequently been concentrated in populations that are already maligned on the basis of race, ethnicity, age, criminality, disability, gender deviation, lower class, caste or poverty. This heritage continues to inform current practices and contributes to ongoing global inequalities of healthcare.
... Nowadays, the scientific community distinguishes, basically, three different surgical approaches to hysterectomy: vaginal, abdominal and laparoscopic. The limitations of conventional laparoscopy have led to the development of robotic surgery, which has evolved over the past decade from simple adjustable arms to support cameras in laparoscopic surgery to more sophisticated four-armed machines now being in use worldwide [4]. However, the American College of Obstetricians and Gynecologists (ACOG) continues to recommend VH as the approach of choice whenever feasible. ...
Objective
The aim of this study was to describe, from a historical perspective, the relevance, resilience and outcomes of vaginal hysterectomy (VH) in gynecology in the age of technological scenario.
Methods
The authors searched records from January 2011 to January 2021 on the following databases: Medline, EMBASE, and CENTRAL (The Cochrane Library) for combinations of the terms “vaginal hysterectomy,” “outcomes” AND “history”; and before that period, if the search had historical relevance. Inclusion criteria: randomized clinical trials; hysterectomy performed for benign gynecological conditions; and VH outcomes compared with Abdominal Hysterectomy (AH), Laparoscopic Hysterectomy (LH) or Robotic Hysterectomy (RH).
Results
The VH combines sequences of reproducible techniques which have been developed over the years to safely and effectively overcome the limitations of difficult cases of vaginal extirpation from the uterus.
Conclusion
The authors support endoscopic surgical approaches in complex surgery for benign indications, urogynecology, and gynecologic oncology when appropriate. However, what makes the gynecological surgeon different from the general surgeon is the vaginal access. It is essential to continue to train residents in vaginal surgical skills and provide safe and cost-effective patient care. The art of technology is the resilience of keeping only the patient at the center of innovation.
... The most common symptoms are abnormal uterine bleeding, pelvic pain, dysmenorrhea, and infertility. The most common indication for hysterectomy is myoma uteri and 40-60% of hysterectomies are performed due to myoma uteri (4,5). ...
... We detected significant differences between the benign and malign cases in terms of age, complaint during the consultation, and cervical smear results. Myoma uteri, which affects 70-80% of reproductive-aged women, is the most common indication for hysterectomy, constituting 40-60% of all hysterectomy indications (4,5,12). The most common symptoms are abnormal uterine bleeding, pelvic pain, dysmenorrhea, and infertility. ...
Malignant pathologies may be observed in the histopathological examination of the patients who were operated with the diagnosis of myoma uteri. We aimed to investigate the rates of detection of uterine sarcoma, smooth muscle tumor of uncertain malignant potential and benign myoma variants who were operated due to myoma uteri. Patients who were operated with the diagnosis of myoma uteri between 2012-2018 were included. Patients with and without malignant pathology were compared in terms of their characteristics. The malignancy was encountered in 39 patients (1.5%) among 2583 patients. A significant difference was found between the patients with and without malignancy in terms of age, admission complaints, and cervical smear results. Patients in the malignant group were found to be older (52.5±11.0 vs 48.1±6.1, p=0.016). Postmenopausal bleeding was significantly a more common complaint in the malignant group (p=0.028). The rate of abnormal cytology in the cervical smear results in the malignant group was 5.1% (p=0.004). Pathology reports of the patients who were operated for myoma uteri may result with malignancy. In the preoperative evaluation, it is necessary to pay attention to the patients’ characteristics, to evaluate the risk factors for the possibility of a malignancy.
... Доброякісні новоутворення тіла матки, яєчників, сальпінгіти (піосальпінкс, гідросальпінкс) є досить поширеними, лише міома матки діагностується у 20-25 % дорослого жіночого населення [5][6][7][8]. При невчасному виявленні та хірургічному лікуванні такі патології теж можуть викликати загрозливі стани та ускладнення, а також стати причиною до 60 % гістеректомій [9]. Саме тому рекомендовано проводити хірургічне лікування якнайшвидше після виявлення патології, особливо з теперішнім розвитком лапароскопії, що дозволяє малоінвазивно виконувати операції з мінімальними ризиками та тривалістю реабілітації, використовуючи підхід ERAS [10]. ...
... Особливо наполегливо рекомендовано виконувати паралельне лікування пацієнтам, які потрапили до стаціонару з різних причин, усіх виявлених патологій паралельно (особливо хірургічних), що приводить до збільшення ефективності, зменшення сумарного часу, витраченого на лікування, та ресурсів, задіяних у цей час в розрахунку на одного пацієнта (не останню роль відіграє і зниження кількості ускладнень зі зменшенням сумарного часу перебування у стаціонарі) [12]. Постає питання розвитку симультанних лапароскопічних операційних втручань для лікування ЖКХ та супутньої гінекологічної патології, як найважливішої складової стаціонарного лікування, щоб задовольнити вимоги до раннього хірургічного лікування жовчнокам'яної хвороби (ЖКХ) [1,4,13] та гінекологічної хірургічної патології (ГП) одночасно [9,10]. ...
Мета дослідження – порівняти розроблену техніку симультанних операційних втручань із звичайною технікою лапароскопічної холецистектомії за такими показниками, як безпека, час операції, час стаціонарного лікування, рівень ускладнень, втома хірургів після операцій.
Матеріали та методи. У період із 2015 до 2019 р. у ВІМДЛ ВОКЛ 284 пацієнтам були виконані операції. Хворих було поділено на дві групи: перша – 72 пацієнтки із поєднаною гінекологічною патологією (ГП) та жовчнокам’яною хворобою (ЖКХ) та друга – 212 пацієнток лише із жовчнокам’яною хворобою. Статистику опрацьовано у програмі «Statistica v12.6». Використано аналіз критерію Шапіро–Уїлка, статистичні методи порівняння Манна–Уїтні, або U-критерій та ANOVA. Критичний рівень значущості р у всіх розрахунках визначено як 0,05.
Результати дослідження та їх обговорення. Час операції склав (53±4,18) хв (31–66 хв) для першої групи і (41±3,77) хв (27–60 хв) – для другої. Зростання на 12 хв, або 23,6 %. Термін стаціонарного лікування склав 3,29 (2–8) дня у першій групі проти 3,32 (2–8) дня у другій (p=0,941). Рівень ускладнень в обох групах був зіставним і не відрізнявся значуще (p=0,966). Зміна критичної частоти злиття мерехтінь (КЧЗМ) у першій групі становила 2,25 Гц, а у другій – 2,18 Гц (p=0,928). Відносна сила знизилась у досліджуваній групі на 5,96 %, а в контрольній – на 5,73 % (p=0,970). Різниця у показниках між групами була незначущою, крім часу операції. Зростання було незначним, що не може конкурувати із показниками окремої операції.
Висновки. 1. Виконання симультанних лапароскопічних втручань розробленою технікою для лікування жовчнокамʼяної хвороби та поєднаної хірургічної гінекологічної патології не приводить до збільшення тривалості лікування у стаціонарі, збільшення кількості ускладнень, фізичної чи психологічної втоми хірургів. 2. Збільшення тривалості операції не було критичним і не може конкурувати в часі з однією окремою операцією для цієї патології. 3. Симультанні лапароскопічні операції є оптимальними для хворих із поєднаною ЖКХ та ГП, а техніка, розроблена на базі ВІМДЛ ВОКЛ, є оптимальним вибором для виконання таких операцій.
... He first described a technique for laparoscopic assisted vaginal hysterectomy (LAVH) in 1984. Four years later Harry Reich performed the first total laparoscopic hysterectomy (TLH) in Pennsylvania on a 230 g fibroid uterus [4]. Since minimal invasive surgery became clinical routine, the technique of conventional straight-stick laparoscopy is still demanding in the context of large uteri and challenging in altered anatomy. ...
... Hysterectomy is one of the most common surgical procedures around the world. 1,2 Hysterectomy is described as removal of the uterus either with or without the cervix using various surgical procedures including laparoscopy. There are two types of hysterectomy as total hysterectomy (TH) and supracervical hysterectomy (SCH). ...
... [20,21] Since its publication in 1989, LAVH has been increasingly used in clinical practice and is currently considered a safe and viable technology for the treatment of benign uterine diseases, it has been recommended as an alternative to TAH for early EC. [22,23] TVH had beginnings in 1507, [24] in the next half century, TAH began to be used for other indications including EC, [25] although new techniques for hysterectomy are emerging, vaginal hysterectomy remains the safest and most cost-effective method and is supported by numerous organizations, including the American College of Obstetricians and Gynecologists. [26] With the improvement of vision and flexibility, robotic minimally invasive surgery technology has been developed, which breaks through the limitations of traditional laparoscopic surgery. ...
Background:
Endometrial cancer (EC) is one of the most common gynecologic tumors, with a high incidence in developed countries. Although the overall prognosis is good, some women have invasive tumors, the risk of recurrence, and death is high. The common surgical methods used in EC are total-abdominal hysterectomy (TAH), total-vaginal hysterectomy (TVH), laparoscopic-assisted vaginal hysterectomy (LAVH), and total-laparoscopic hysterectomy (TLH) including both conventional and robotically assisted.
Methods:
The literature search was performed in The Cochrane Central Register of Controlled Trials, PubMed, Web of Science, and Embase. The randomized controlled trials (RCTs) will be included. The search date is until June 2019. The risk of bias of included RCTs was assessed by 2 investigators according to the Cochrane Collaboration's tool. Network meta-analysis will be conducted by R software.
Results:
This study is ongoing and the results will be submitted to a peer-reviewed journal for publication.
Conclusion:
This network meta-analysis will provide clinical staff with current and reliable information on the best surgical approach for EC. Ethical approval is not applicable, since this is a network mate-analysis based on published articles. The protocol has been registered on PROSPERO under the number CRD42019128094.
... Temisón de Laodicea 123-43 a. de J.C, citado por Sparic R, et al., (7) perteneciente a la escuela de Alejandría, aseguraba que el útero podría ser extirpado sin causar la muerte. ...
... Paradójicamente la primera HV con éxito fue realizada por una paciente en 1670, como fue informado por Percival Willouby y recogido en las publicaciones de Sparic R, et al, (7) y Sutton C (10) una vieja campesina de 46 años llamada Fe Haworth estaba llevando una carga pesada de carbón cuando su útero se derrumbó completamente. Frustrada por la ocurrencia frecuente de este mal ella agarró el útero, tiró tan duro como le fue posible y cortó la porción entera con un corto cuchillo. ...
Fundamento:
La histerectomía, después de la operación cesárea es la cirugía ginecológica que más se realiza; esta se puede hacer por diferentes vías: la abdominal, vaginal y laparoscópica; de todas ellas la vaginal tiene una significación histórica.
Objetivo:
Analizar las diferentes etapas históricas de la histerectomía vaginal como técnica quirúrgica.
Metodología:
Se revisaron documentos publicados en diferentes bases de datos (PubMed, Medline, Redalyc, Hinari, Ebsco) en idioma inglés y español. Se escogieron los que aportaron datos históricos. Se utilizó el método histórico-lógico para el análisis de las diferentes etapas del desarrollo de la histerectomía vaginal y el de análisis y síntesis para determinar las relaciones entre las diferentes etapas que caracterizaron a la técnica y su contribución a la técnica actual.
Resultados:
Se revisaron un total de 223 artículos, de los cuales se seleccionaron 42 que contenían datos históricos y las características de los procederes, así como las fechas.
Conclusiones:
El desarrollo de la histerectomía vaginal ha sufrido cambios a través de los tiempos en las indicaciones y la forma de realizarse lo cual ha influido en que en la actualidad en muchos países se ha convertido en la técnica de elección de la histerectomía.
