Senhance robotic platform for ovarian borderline tumor treatment: minimally invasive robotic approach for conservative adnexal surgery

Introduction

The robotic platforms have become reality in the endoscopic field. Different technologies are suitable with different characteristics (1,2). Thanks to the innovative technology, robotic surgery has acquired a leading role in gynecologic surgery. Nowadays, the applications of robotics are used for both malignant and benign conditions. However, one of the main limits is represented by high costs and increased operative time (3).

In this context, the Senhance (TransEnterix Surgical Inc., Morrisville, NC, USA) robotic platform represents an alternative in this field. This technology is characterized by 3D eye-tracking camera and haptic feedback (4,5). The independent robotic arms are installed in common 5- or 3-mm trocars that can be placed wherever in the surgical field (6) allowed recreating a standard gynecological laparoscopic setting with the advantages of the robotic arms.

The present surgical technique article is aimed to show the conservative staging for borderline ovarian tumor approached with the Senhance platform.

Operative technique

The surgical case consists of robotic-assisted right ovarian cyst enucleation in a 29 years old patient, body mass index (BMI) 24 with history of menstrual dysfunction and infertility. Previous laparoscopic left salpingo-oophorectomy for ovarian torsion, nulliparous woman. Ultrasound (US) pelvic scan showed 5 cm right ovarian mass, suspected for borderline ovarian tumor, with mild CA 125 tumor marker increasing (45 µg/mL). The patient gave her consent to the publication of her data for the publication of this study.

The surgical procedure is showed in the video (Video 1).

The surgical setting adopted was the same as standard laparoscopy, with 12 mm umbilical trocar, and 5 mm trocar in left and right iliac fossa, and one in suprapubic area. The suprapubic trocar was used by the assistant surgeon. The ovary was incised and dissected to find the cyst dissection plan. The cyst was then enucleated using the stripping technique. In this maneuver, the haptic feedback allowed to dose the traction applied, avoiding the cyst rupture. The hemostasis was controlled using the bipolar robotic grasper. The cyst was extracted using an endo-bag from umbilical access. The ovary was then sutured using 2/0 Vicryl stitch running suture using the robotic needle-holder. The procedure was completed with peritoneal and omental biopsies performed by standard laparoscopy that, considering the setting adopted, did not required any change in the surgical setting allowing a fast and easy procedure completion.

The operative time was 40 and 9 minutes for robotic arms installation. The estimated blood loss was 25 mL. The hospital stay was 1 day without early and late complications recorded.

Comments

The Senhance platform was deeply investigated in the last years and tested in different pathologies as benign and malignant conditions reporting good results even compared with standard laparoscopy (7).

Moreover, the platform was tested even in a subset of obese patients with good perioperative outcomes (4). Nowadays, the endoscopic surgery is moving towards a reduction in the number and size of the surgical instruments used (8,9).

The present surgical technique video showed a conservative adnexal surgery. The Senhance platform with the haptic feedback allowed to measure the tissue traction to avoid the cyst rupture. The operative time was in line with the literature. Considering all these aspects the platform is an attractive technology not only for demolitive surgery but even for conservative adnexal surgery.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Gynecology and Pelvic Medicine for the series “Laparoscopic Surgery for Ovarian Cancer”. The article has undergone external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gpm.amegroups.org/article/view/10.21037/gpm-20-27/coif). The series “Laparoscopic Surgery for Ovarian Cancer” was commissioned by the editorial office without any funding or sponsorship.SC served as the unpaid Guest Editor of the series, and serves as an unpaid editorial board member of Gynecology and Pelvic Medicine from Nov 2019 to Oct 2021. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this study and any accompanying images.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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