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Advanced Minimally Invasive Surgery in Gynecology

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (1 May 2023) | Viewed by 22461

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Special Issue Editors

Dr. Tae-Joong Kim

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Guest Editor

Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
Interests: gynecologic cancers; single-port surgery; natural orifice transluminal endoscopic surgery (NOTES); robotic surgery; image-guided surgery; lymphatic mapping; innovative techniques
Special Issues, Collections and Topics in MDPI journals

Dr. Valerio Gallotta

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Guest Editor

Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: cervical cancer; minimally invasive surgery; fertility sparing treatments; translational medicine; sentinel lymph node concept; gynecological cancers
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Since the introduction of laparoscopy, remarkable achievements have been made in the field of gynecologic surgery. The impact of these developments on our daily practice cannot be overemphasized.

The theme of this Special Issue of Journal of Personalized Medicine is “Advanced Minimally Invasive Surgery in Gynecology,” wherein the most advanced and cutting-edge innovations in the landscape of gynecologic surgery are provided. The journal invites submissions of research that reflect both practical and technical innovations from our friends and colleagues running the best centers worldwide with expertise in the field. The aim of the Special Issue is to highlight research topics including but not limited to:

Minimally invasive laparoscopic surgery.
Ultra-minimally-invasive laparoscopic surgery.
Single-incision laparoscopic surgery (SILS).
Robot-assisted laparoscopic surgery.
Reduced port surgery.
Vaginal natural orifice transluminal endoscopic surgery (vNOTES).
3D laparoscopic surgery.
Sentinel lymph node mapping and biopsy.
Tactile sensing laparoscopic surgery.
Augmented reality (AR) visualization laparoscopic surgery.
Intraoperative laparoscopic ultrasound.

It is my great honor to serve as the Guest Editor for this Special Issue, and to have an opportunity to be involved in sharing the latest technological innovations in the field of gynecologic surgery.

Dr. Tae-Joong Kim
Dr. Valerio Gallotta
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

minimally invasive laparoscopic surgery
ultra-minimally-invasive laparoscopic surgery
single-incision laparoscopic surgery (SILS)
robot-assisted laparoscopic surgery
reduced port surgery
vaginal natural orifice transluminal endoscopic surgery (vNOTES)
3D laparoscopic surgery
sentinel lymph node mapping and biopsy
tactile sensing laparoscopic surgery
augmented reality (AR) visualization laparoscopic surgery
laparoscopic ultrasound

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Published Papers (10 papers)

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Research

12 pages, 1022 KiB

Open AccessArticle

Diagnostic Clues for Women with Acute Surgical Abdomen Associated with Ruptured Endometrioma

by Jihyun Keum, Won Moo Lee, Joong Sub Choi, Jaeman Bae, Seongsil Cho and Bo Kyeong Kang

J. Pers. Med. 2023, 13(8), 1226; https://doi.org/10.3390/jpm13081226 - 2 Aug 2023

Viewed by 1226

Abstract

(1) Background: An investigation of the preoperative diagnostic clues used to identify ruptured endometrioma by comparing the ruptured and unruptured states in patients who underwent laparoscopic operations due to endometrioma. (2) Methods: Patients with ruptured endometriomas (14 patients) and unruptured endometriomas (60 patients) were included, and clinical symptoms, laboratory findings, and radiological findings were analyzed. (3) Results: There were no significant differences in age, parity, last menstrual cycle days, or median size of endometrioma between two groups (group A: ruptured; group B: unruptured). The median serum level of CA 125 was 345.1 U/mL in group A and 49.8 U/mL in group B (p = 0.000). The median serum levels of CA 19-9 in group A and B were 46.0 U/mL and 19.1 U/mL, respectively (p = 0.005). The median serum level of CRP in group A was 1.2 g/dL, whereas it was 0.3 in group B (p = 0.000). ROC analysis showed that the optimal CA 125 cutoff value was 100.9 U/mL; the optimal CA 19-9 cutoff value was 27.7 U/mL; and the optimal CRP cutoff value was 1.0 g/dL. (4) Conclusions: Ruptured endometrioma can be diagnosed preoperatively using a combination of clinical symptoms, laboratory findings, and radiological findings. If a physician suspects a ruptured endometrioma, surgery should be performed to ensure optimal prognosis. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

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11 pages, 1023 KiB

Open AccessArticle

Robotic Single-Site Radical Hysterectomy for Early Cervical Cancer: A Single Center Experience of 5 Years

by Changho Song, Tae-Kyu Jang, Soomin Kong, Heeju Kang, Sang-Hoon Kwon and Chi-Heum Cho

J. Pers. Med. 2023, 13(5), 733; https://doi.org/10.3390/jpm13050733 - 26 Apr 2023

Cited by 2 | Viewed by 1695

Abstract

Background: The mainstay of treatment for early-stage cervical cancer is surgery; we present a 5-year experience of robotic single-site radical hysterectomy (RSRH) focused on surgical and oncologic outcomes. Methods: This retrospective study included 44 cases of RSRH performed in patients with early-stage cervical cancer. Results: The median follow-up period for the 44 patients was 34 months. The mean total operation time was 156.07 ± 31.77 min, while mean console time was 95.81 ± 24.95 min. Two cases had complications, which required surgical management, while four cases (9.1%) exhibited recurrence. The disease-free survival rate at 5 years was 90.9%. The sub-division analysis showed that Stage Ia2 and stage Ib1 patient sub-group showed better DFS than that of the stage Ib2 patient sub-group. The learning curve analysis showed that the CUSUM-T initially peaks at the sixth case then gradually decreases before rising and peaking at the 24th case. After 24th case, the CUSUM-T gradually decreases and reaches zero. Conclusion: The surgical outcomes of RSRH for early-stage cervical cancer treatment were safe and acceptable. However, RSRH could be considered carefully only in well-selected patient groups. Large-scale prospective studies are necessary in the future to validate the results. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

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8 pages, 229 KiB

Open AccessArticle

Comparison of Surgical Outcomes between Single-Port Laparoscopic Surgery and Da Vinci Single-Port Robotic Surgery

by Jeong-Min Kim, Seon-Mi Lee, Aeran Seol, Jae-Yun Song, Ki-Jin Ryu, Sanghoon Lee, Hyun-Tae Park, Hyun-Woong Cho, Kyung-Jin Min, Jin-Hwa Hong, Jae-Kwan Lee and Nak-Woo Lee

J. Pers. Med. 2023, 13(2), 205; https://doi.org/10.3390/jpm13020205 - 24 Jan 2023

Cited by 5 | Viewed by 2356

Abstract

Background: The aim of this study is to compare the surgical outcomes of single-port laparoscopic surgery (SPLS) and single-port robotic surgery (SPRS). Methods: We retrospectively analyzed patients who underwent a hysterectomy, ovarian cystectomy, or myomectomy with SPLS or SPRS from January 2020 to July 2022. Statistical analyses were performed using the SPSS chi-square test and student’s t-test. Results: A total of 566 surgeries including single-port laparoscopic hysterectomy (SPLH; n = 148), single-port robotic hysterectomy (SPRH; n = 35), single-port laparoscopic ovarian cystectomy (SPLC; n = 207), single-port robotic ovarian cystectomy (SPRC; n = 108), single-port laparoscopic myomectomy (SPLM; n = 12), and single-port robotic myomectomy (SPRM; n = 56). The SPRH, SPRC, and SPRM groups had a shorter operation time than the SPLS group, although the results were not statistically significant (SPRH vs. SPLH, p = 0.134; SPRC vs. SPLC, p = 0.098; SPRM vs. SPLM, p = 0.202). Incisional hernia occurred as a postoperative complication in two patients only in the SPLH group. Postoperative Hb changes were lower in the SPRC and SPRM groups than in the SPLC and SPLM groups (SPRC vs. SPLC, p = 0.023; SPRM vs. SPLM, p = 0.010). Conclusions: Our study demonstrated that the SPRS had comparable surgical outcomes when compared to the SPLS. Therefore, the SPRS should be considered a feasible and safe option for gynecologic patients. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

7 pages, 225 KiB

Open AccessFeature PaperArticle

Effects of Using Barbed Suture in Myomectomy on Adhesion Formation and Adverse Pregnancy Outcome

by Seyeon Won, Su Hyeon Choi, Nara Lee, So Hyun Shim, Mi Kyoung Kim, Mi-La Kim, Yong Wook Jung, Bo Seong Yun and Seok Ju Seong

J. Pers. Med. 2023, 13(1), 92; https://doi.org/10.3390/jpm13010092 - 30 Dec 2022

Cited by 2 | Viewed by 1738

Abstract

Background: There is still concern regarding postoperative adhesion formation and adverse effects on pregnancy outcomes caused by barbed suture (BS) after myomectomy. The aim of this study was to compare the postoperative adhesion and pregnancy outcomes between conventional suture (CS) and BS after minimally invasive myomectomy (MIM) by robotic myomectomy (RM) or laparoscopic myomectomy (LM). Methods: The medical records of 94 women who had undergone MIM with CS and 97 who had undergone MIM with BS and achieved pregnancy were reviewed. Postoperative adhesion was evaluated following cesarean section. Results: The number of removed myomas was greater (5.3 ± 4.6 vs. 3.5 ± 3.1, p = 0.001) and the size of the largest myoma was larger (7.0 ± 2.2 vs. 5.8 ± 2.7 cm, p = 0.001) in the BS group relative to the CS group. A total of 98.9% of patients in the CS group and 45.4% in the BS group had undergone LM (p < 0.001), while the others underwent RM. There was no significant difference in the presence of postoperative adhesion at cesarean section between the BS and CS groups (45.5 vs. 43.7%, p = 0.095). Additionally, there were no intergroup differences in pregnancy complications such as preterm labor, placenta previa, accrete or abruption. Note also that in our logistic regression analysis, the suture type (BS or CS) was excluded from the independent risk factors regarding postoperative adhesion formation. Conclusions: Our data indicated that the incidence of postoperative adhesion after MIM with BS was similar when compared with CS. Also it seems that the suture type does not have a significant effect on pregnancy outcomes. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

10 pages, 1480 KiB

Open AccessArticle

Coaxial-Robotic Single-Site Myomectomy: Surgical Outcomes Compared with Robotic Single-Site Myomectomy by Propensity Score Matching Analysis

by Su Hyeon Choi, Seyeon Won, Nara Lee, So Hyun Shim, Mi Kyoung Kim, Mi-La Kim, Yong Wook Jung, Bo Seong Yun and Seok Ju Seong

J. Pers. Med. 2023, 13(1), 17; https://doi.org/10.3390/jpm13010017 - 22 Dec 2022

Cited by 2 | Viewed by 1709

Abstract

Background: The aim of this study was to introduce a coaxial-robotic single-site myomectomy (C-RSSM) technique to compensate for the shortcomings of robotic single-site myomectomy (RSSM) using semi-rigid instruments and to compare the surgical outcomes of C-RSSM and RSSM. Methods: The medical records of 13 consecutive women who had undergone C-RSSM and 131 consecutive women who had undergone RSSM were retrospectively reviewed. Patient characteristics and surgical outcomes after propensity score matching were evaluated and compared between the two groups. Results: According to the propensity score matching results, the C-RSSM group had a lower estimated blood loss (75.0 vs. 210.5 mL, p = 0.001) and a shorter operating time (101.0 vs. 146.1 min, p = 0.008) relative to the RSSM group. In RSSM, there was one case of conversion to conventional laparoscopy and four cases of conversion to the multi-site robotic approach. There was no case of conversion from C-RSSM to conventional laparoscopy or the multi-site robotic approach. Conclusions: C-RSSM was found to be associated with shorter operative time and lower estimated blood loss. However, further prospective studies are needed to confirm these advantages. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

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7 pages, 384 KiB

Open AccessArticle

Comparison of Surgical Outcomes of Robotic versus Conventional Laparoscopic Hysterectomy of Large Uterus with Gynecologic Benign Disease

by Soo Young Jeong, Kyoungseon Kim, Ji Won Ryu, Jieum Cha, Sung Taek Park and Sung Ho Park

J. Pers. Med. 2022, 12(12), 2042; https://doi.org/10.3390/jpm12122042 - 10 Dec 2022

Cited by 3 | Viewed by 2310

Abstract

Hysterectomy is commonly performed for benign gynecological diseases. Minimally invasive surgical approaches offer several advantages. Unfortunately, few studies have compared the outcomes of different types of minimally invasive surgeries. Therefore, this study aimed to compare the surgical outcomes of robotic hysterectomy (RH) and conventional laparoscopic hysterectomy (CLH) in benign gynecologic diseases. We performed a retrospective cohort study at a single center between January 2014 and July 2022. A total of 397 patients (RH: 197 and CLH: 200) who underwent minimally invasive hysterectomy for benign diseases with uterine size exceeding 250 g were enrolled, and factors related to the surgical outcomes were compared. The median age was 46 (range, 35–74) years, and the median uterine weight was 400 (range, 250–2720) g. There were no significant differences between the two groups regarding age, body mass index, uterine weight, hospital stay, estimated blood loss, or operating time. Intraoperative and postoperative complication rates were not significantly different between the two groups. RH was not inferior to CLH in terms of perioperative and immediate postoperative outcomes in our study. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

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8 pages, 25798 KiB

Open AccessArticle

Comparison of Surgical Outcomes of Adnexectomy by Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Versus Single-Port Access (SPA) Surgery

by Jihee Jung, Joseph J. Noh, Jungeun Jeon, Chi-Son Chang and Tae-Joong Kim

J. Pers. Med. 2022, 12(12), 1996; https://doi.org/10.3390/jpm12121996 - 2 Dec 2022

Cited by 3 | Viewed by 3964

Abstract

The objective of the present pilot study is to compare operative outcomes between vaginal natural orifice transluminal endoscopic surgery (vNOTES) and single-port access (SPA) adnexectomy. Subjects were patients who underwent adnexectomy for benign adnexal disease, from November 2019 to May 2021. A total of 12 patients underwent vNOTES adnexectomy, and 55 patients received SPA laparoscopic adnexectomy. All surgeries were performed by one surgeon. In order to balance the baseline characteristics of the patients, 1:2 matching was performed. The vNOTES group demonstrated a low postoperative pain score within 12 h after surgery. They also required less use of analgesic medications postoperatively. Other surgical outcomes were comparable between the two groups. This study showed that vNOTES adnexectomy has comparable surgical outcomes to SPA. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

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8 pages, 217 KiB

Open AccessArticle

Evaluation of the Quality and Influence of YouTube as a Source of Information on Robotic Myomectomy

by Hye-yon Cho and Sung-ho Park

J. Pers. Med. 2022, 12(11), 1779; https://doi.org/10.3390/jpm12111779 - 28 Oct 2022

Cited by 1 | Viewed by 1325

Abstract

Background: We aimed to evaluate the usefulness of YouTube videos for helping patients become informed about robotic myomectomy. Methods: We searched YouTube using “robotic myomectomy” and “Da Vinci myomectomy.” Videos were sorted by view count, with the 150 most highly viewed videos being selected. From each video, content type, source, view count, video length, time on YouTube, likes, and dislikes were extracted. A scoring system was used to evaluate video quality. Results: The most prevalent content was recordings of actual surgical procedures of robotic myomectomy, and the most common provider was gynecologic surgeons. Videos directly related to robotic myomectomy were mainly provided by medical groups, had been present on YouTube for a significantly longer time (p = 0.003), and had a higher rate of no responses from viewers (p = 0.014) than videos indirectly related to robotic myomectomy. Videos uploaded by nonmedical groups had more likes, more dislikes, and a higher view ratio (p = 0.029, 0.042, and 0.042, respectively). Scores reflecting video quality did not differ between the two groups. Multiple logistic regression revealed that low-quality videos (less than score 5) were significantly correlated with content indirectly related to robotic myomectomy, poor general quality, fewer views, fewer likes, and no response by viewers. Conclusions: Patients who want to get informed about robotic myomectomy on YouTube should exclude low-quality videos according to such parameters as content, views, and response by viewers. In addition, medical groups should provide videos of good quality for instructing patients about this procedure. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

8 pages, 728 KiB

Open AccessArticle

Robotic Single-Site Plus Two-Port Myomectomy versus Conventional Robotic Multi-Port Myomectomy: A Propensity Score Matching Analysis

by Seyeon Won, Su Hyeon Choi, Nara Lee, So Hyun Shim, Mi Kyoung Kim, Mi-La Kim, Yong Wook Jung, Bo Seong Yun and Seok Ju Seong

J. Pers. Med. 2022, 12(6), 928; https://doi.org/10.3390/jpm12060928 - 3 Jun 2022

Cited by 6 | Viewed by 2144

Abstract

Background: Robotic single-site plus two port myomectomy (RSTM) was designed to reduce the number of incision sites while retaining the advantage of conventional robotic multi-port myomectomy (CRM). This study aimed to explicate RSTM and compare surgical outcomes between it and CRM. Methods: The medical records of 146 patients who had undergone RSTM and 173 who had undergone CRM were reviewed. The surgical outcomes between them were compared by propensity score matching (PSM) analysis. Results: The PSM analysis showed no statistically significant inter-group differences in patient characteristics. With regard to surgical outcomes, the RSTM group enjoyed shorter operative time (148.30 ± 44.8 vs. 162.3 ± 47.4 min, p = 0.011), less hemoglobin decrement (1.8 ± 0.9 vs. 2.3 ± 1.0 g/dL, p < 0.001), and shorter duration of hospital stay (5.4 ± 0.7 vs. 5.8 ± 0.7 days, p < 0.001). Conclusions: RSTM was associated with shorter operative time relative to CRM. Further prospective studies are needed in order to more fully investigate the advantages of RSTM. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

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10 pages, 1200 KiB

Open AccessArticle

Comparison of Surgical Outcomes of Hysterectomy by Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) versus Single-Port Access (SPA) Surgery

by Joseph J. Noh, Myeong-Seon Kim, Jun-Hyeok Kang, Ji-Hee Jung, Chi-Son Chang, Jungeun Jeon and Tae-Joong Kim

J. Pers. Med. 2022, 12(6), 875; https://doi.org/10.3390/jpm12060875 - 26 May 2022

Cited by 10 | Viewed by 2675

Abstract

Single-port access (SPA) laparoscopic surgery and vaginal natural orifice transluminal endoscopic surgery (vNOTES) have many advantages. The objective of the present study is to compare patient characteristics, operative details, and postoperative outcomes between the two surgical methods. Patients who were planned to undergo vNOTES or SPA laparoscopic surgery between April 2020 and June 2021 were prospectively enrolled. The surgical method was determined by a single surgeon after imaging results evaluation and a physical exam. Those who had favorable pelvic conditions without any evidence of adhesion were scheduled for vNOTES. A total of 33 patients underwent a vNOTES hysterectomy while 40 patients received a SPA laparoscopic hysterectomy. All surgeries were performed by one surgeon. The proportion of the patients who had a history of vaginal delivery was significantly higher in the vNOTES group. The operative time for port installation was significantly longer in the vNOTES group, but the total operative time was shorter compared to the SPA group. The postoperative pain scores 12 h after the operations were also significantly lower in the vNOTES group. Other surgical outcomes were comparable between the two groups. The present study demonstrated that the early operative outcomes of vNOTES hysterectomy were comparable to those of SPA hysterectomy. It also highlights the importance of adequate patient selection when determining surgical methods based on imaging results and physical examinations. Full article

(This article belongs to the Special Issue Advanced Minimally Invasive Surgery in Gynecology)

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