The treatments of gynecological diseases, also known as gynecological diseases, continue to gain diversity with the development of technology. Robotic surgery, which is among the closed surgical methods, is considered the most technological form of minimally invasive (small incision) surgery, while providing many advantages to the patient and the doctor. Among the application areas of robotic surgery; Treatment of uterine, cervical and ovarian cancers, removal of the uterus, urinary incontinence and uterine prolapse, removal of fibroids, endometriosis and removal of ovarian cysts are included. The robotic surgery method, which is applied closed via robotic arms controlled by the surgeon, brings advantages such as shortening the hospital stay, less pain and bleeding, and a shorter return to social life. Associate Professor from the Department of Obstetrics and Gynecology and Gynecological Oncology at Memorial Ankara Hospital. Dr. Murat Öz gave information about the use of robotic surgery method in the treatment of gynecological diseases.

What is robotic surgery in gynecological diseases?

In parallel with the advancement of technology, there are very important developments in surgical methods and surgical techniques all over the world. The main purpose of these developments is to perform the surgeries more safely, to decrease the complication rates and to minimize the undesired results related to the surgery. The most important progress in this regard; operations that used to be performed in the form of open surgery can now be performed with minimally invasive methods, that is, closed. The latest technology in closed surgeries is robotic surgery systems. To put it simply, robotic surgery is the closed operation of the surgeon-controlled robotic arms. Compared to traditional laparoscopic surgeries, the robotic system has many advantages.

In which situations is robotic surgery applied in gynecological diseases?

There is no situation in which robotic surgery should not be used in gynecological diseases. Robotic surgery can be performed whenever laparoscopic surgery is appropriate. Robotic surgery can be applied in the surgery of uterine, cervical and ovarian cancers, removal of fibroids, uterus removal surgeries (hysterectomy), endometriosis surgeries, ovarian cysts, urinary incontinence and uterine prolapse.

However, there are some cases where the advantage of closed surgery compared to open surgery is technically reduced. In these cases, open surgery may be preferred instead of robotic surgery.

How is robotic surgery applied in gynecological diseases?

Patient preparation in robotic surgery is very similar to the traditional laparoscopic method. After the patient is taken to the operating table and anesthesia is given, the footrests are attached and the patient is placed in the gynecological examination position. Then, a special needle is inserted into the abdomen through a tiny incision made about 3 cm above the navel, and the abdomen is inflated with carbon dioxide gas. When a pressure of approximately 15 mmHg is reached, the trocar (metal tube or sheath through which surgical instruments can enter and exit) is inserted into the abdomen through a 7 mm incision made 3 cm above the navel. The camera of the robotic system is advanced into the abdomen from the first inserted trocar and the first image of the organs in the abdomen is obtained. After this stage, the operating table is turned upside down at an angle of approximately 35 degrees. In order for the patient not to slide down from the table, the feet are fixed on the footrests and shoulder supports are placed on the shoulders. Depending on the type of surgery to be performed, the number of trocars that will be operated with a total number of robotic arms is entered into the abdomen under the image of the first inserted camera. Trocars are usually placed in the abdomen in a straight line or a slight crescent shape, and there should be a distance of at least 8 cm between the two trocars. After all the trocars are placed, the robotic instruments to be used are conveyed into the abdomen through the appropriate trocars, and finally, the instruments are connected to the robotic arms and they are ready for surgery.

Myomectomy: The robotic system provides a great advantage in the surgical treatment of myomas, which is a problem that can be seen in a significant portion of women of reproductive age. The most important step in myoma surgery with the closed method is to close the incisions in the uterus in a solid and multi-layered way after removing the fibroids. Failure to close the incisions in the uterus properly after fibroid removal increases the risk of uterine rupture in subsequent pregnancies. In myomectomies performed with the robotic system, the suturing of the incisions is much easier and safer since the robotic arms can imitate the wrist movements in all axes.

Hysterectomy (Uterine removal surgery): All uterus removal procedures suitable for closed surgery can be performed with a robotic system. Thanks to the three-dimensional and high-quality image