8 - The role of robotics and the future

Summary

Introduction

Laparoscopic surgery has become an essential part of the surgical treatment for gynaecological conditions including malignancy. It has been used widely for the treatment of early cervical and endometrial cancer, and for staging in gynaecological cancers. Despite the advantages and advances of laparoscopic surgery, a number of limitations exist. These include difficulties in manipulating the camera, the two-dimensional view, the constraints of straight instruments, physical problems for the surgeon and the difficulties for trainees in learning the technique.

Robotically assisted laparoscopic surgery has the capacity to overcome the limitations of conventional laparoscopic surgery and it could enable future development of more advanced surgery with less morbidity. Initial case series show robotically assisted surgery to be as effective as conventional laparoscopic surgery, if more expensive. However, randomised studies and studies demonstrating survival data are lacking.

This chapter describes the use of conventional laparoscopic surgery in gynaecological cancer, the advantages and disadvantages of robotic surgery, and the feasibility and outcomes of the use of robotics in gynaecological cancer surgery. The final section looks at future developments.

Conventional laparoscopic surgery in gynaecological malignancy

Conventional laparoscopic surgery has been widely used for total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy for the treatment of endometrial cancer, and for laparoscopic radical hysterectomy for the treatment of cervical cancer.

Two large randomised controlled studies have looked at the laparoscopic treatment of endometrial cancer.