Robotic single port total laparoscopic hysterectomy for endometrial cancer patients

Objective We present the technique to perform single access robotic laparoscopy for endometrial cancer treatment. Methods Four patients with histological diagnosis of endometrial adenocarcinoma G1 and instrumental FIGO stage IA or IB underwent total single access robotic laparoscopic extra-fascial hysterectomy and bilateral salpingo-oophorectomy. The procedure was performed through a single trans-umbilical incision of 35 mm using a Da Vinci Robotic S System and a Gelport device with one 12 mm trocar for robotic 3D optic, two 8-mm trocars and one 5-mm trocar. Surgeries followed the classic laparoscopic technique using a 12 mm 0 degrees robotic camera, EndoWrist bipolar forceps, EndoWrist monopolar scissors, an EndoWrist needle holder and a laparoscopic suction irrigation and grasper. Vaginal cuff was repaired with an intra-corporeal suture using a barbed wound closure system. Results The planned surgical procedures were successfully completed. Two Cl, endometrial cancer FIGO stage IA and two IB were treated. Median BMI was 25.65 (range, 22 to 29.3). Median total operative time was 183 min (range, 160 to 250). Median docking time was 14 min (range, 11 to 17 min). Median blood loss was 50 mL (range, 10 to 90 mL). No cases required multiple abdominal accesses. None of the patients were converted to laparoscopy or laparotomy. No intra-operative or postoperative complications occurred. All patients were discharged on day two. Conclusions Robotic single-port trans-umbilical total hysterectomy and bilateral salpingo-oophorectomy is technically feasible and reproducible in patients with low-stage endometrial cancer. Despite encouraging results regarding surgical outcome and postoperative course, additional studies are needed to demonstrate the benefits of this technique.