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Robotic-Assisted Laparoscopic Ovarian Cystectomy during Pregnancy

, M.D. 1 , , M.D. 3 , , M.D. 2

AJP Reports

Thieme Medical Publishers

Robotic surgery, adnexal masses, complications of pregnancy

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      Abstract

      The use of robotic-assisted laparoscopic surgery (RALS) in gynecologic oncology is rising rapidly; however, the role of this modality in obstetrics has not been widely investigated. During pregnancy, the surgical management of adnexal masses is traditionally approached via laparotomy or laparoscopy. RALS offers a minimally invasive approach secondary to improved instrument dexterity and precision, 14-fold magnification, and 3-D imaging. For the pregnant patient, this translates into minimal manipulation of the gravid uterus, quicker recovery times, and potentially decreased maternal and fetal morbidity. Here we report six cases in which the da Vinci robotic surgical system (Intuitive Surgical Incorporated, Sunnyvale, CA) was used to perform an ovarian cystectomy during pregnancy. Pathology in all cases returned benign and each patient continued pregnancy without complications of surgery. In centers with the resources and adequately trained physicians, RALS offers the obstetric patient a safe and less invasive alternative to laparotomy or conventional laparoscopy. Although the advantages of robotic surgery are many, the limitations of this modality remain elevated equipment costs as well as the time investment necessary to train physicians.

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      Most cited references 5

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      Robotic gynecologic surgery.

      The objective of this article is to review the recent adoption, experience, and applications of robot-assisted laparoscopy in gynecologic surgery. The use of robotics in gynecologic surgery is increasing in the United States. Robotic-assisted laparoscopic surgeries in gynecology include benign hysterectomy, myomectomy, tubal reanastomoses, radical hysterectomy, lymph node dissections, and sacrocolpopexies. The majority of the current literature includes case series of various robotic surgeries. Recently, comparative retrospective and prospective studies have demonstrated the feasibility of this particular type of surgery. Although individual studies vary, robot-assisted gynecologic surgery is often associated with longer operating room time but generally similar clinical outcomes, decreased blood loss, and shorter hospital stay. Robot-assisted gynecologic surgery will likely continue to develop as more gynecologic surgeons are trained and more patients seek minimally invasive surgical options. Well-designed, prospective studies with well-defined clinical, long-term outcomes, including complications, cost, pain, return to normal activity, and quality of life, are needed to fully assess the value of this new technology.
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        Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management.

        Our purpose was to determine maternal and fetal outcome in patients undergoing surgery for pelvic mass in pregnancy. Maternal and fetal records of 130 cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or aspiration or that were diagnosed incidentally at the time of cesarean section were reviewed. The chi(2) and Fisher's exact tests were used for statistical analysis. A P value of
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          Adnexal masses and pregnancy: a 12-year experience.

          Our purpose was to describe pregnancy-associated adnexal masses in eastern North Carolina. A retrospective study was performed of 60 adnexal masses resected during pregnancy at a regional referral hospital from January 1990 to March 2002. Adnexal masses occurred in 0.15% of pregnancies. Average gestational age at diagnosis and surgery was 12 and 20 weeks, respectively. Fifty percent of ovarian tumors were mature cystic teratomas, 20% were cystadenomas, and 13% were functional ovarian cysts. Malignancy occurred in 13%. Tumors with low malignant potential comprised 63% of malignancies. Average cyst size was 11.5 cm for malignancies and 7.6 cm for benign lesions (P value <.05). The preterm birth rate was 9%, the miscarriage rate was 4.7% after elective cases, and average Apgar scores were 7.5 and 8.7 at 1 and 5 minutes. The incidence of malignancy in pregnancy-associated adnexal masses was high. Ultrasonography detected internal excrescences in the majority of tumors with low malignant potential. Fetal outcomes were not affected.
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            Author and article information

            Affiliations
            [1 ]Department of Obstetrics and Gynecology, Chattanooga, Tennessee
            [2 ]Division of Maternal Fetal Medicine, University of Tennessee College of Medicine–Chattanooga, Chattanooga, Tennessee
            [3 ]Chattanooga's Program in Women's Oncology, Chattanooga, Tennessee
            Author notes
            Address for correspondence and reprint requests Susanna Carter, M.D. PGY-4, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine–Chattanooga 979 East Third Street, Suite 720, Chattanooga, TN 37403 sula7@ 123456earthlink.net
            Journal
            AJP Rep
            AJP Rep
            AJP Reports
            Thieme Medical Publishers (333 Seventh Avenue, New York, NY 10001, USA. )
            2157-6998
            2157-7005
            24 January 2011
            September 2011
            : 1
            : 1
            : 21-24
            23705079
            3653550
            10.1055/s-0030-1271220
            01021
            © Thieme Medical Publishers
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