Facts, Views & Vision
in ObGyn

Journal of the European Society for Gynaecological Endoscopy

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The first robotic-assisted hysterectomy below the bikini line with the Dexter robotic system™

I. Alkatout1, T. Becker2, P. Nuhn3, J. Pochhammer2, G. Peters1, K.M. Donald1, L. Mettler1, J. Ackermann1

1 Department of Gynecology and Obstetrics, Kiel School of Gynaecological Surgery, Kurt-Semm-Center of Minimally Invasive and Robotic Assisted Surgery, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
2 Department of Visceral Surgery, Kurt-Semm-Center of Minimally Invasive and Robotic Assisted Surgery, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
3 Department of Urology, Kurt-Semm-Center of Minimally Invasive and Robotic Assisted Surgery, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany

Keywords:

Dexter robotic system, robotic-assisted surgery, hysterectomy


Published online: Mar 28 2024

https://doi.org/10.52054/FVVO.16.1.010

Abstract

Background: Robotic-assisted hysterectomy (RAH) is a widely accepted minimally invasive approach for uterus removal. However, as RAH is typically performed in the umbilical region, it usually results in scars in cosmetically suboptimal locations. This is the first case of RAH with cervicosacropexy performed below the bikini line, using the new Dexter robotic system™.

Objectives: The aim of this article is to show the surgical steps of the first RAH with cervicosacropexy performed below the bikini line with the new Dexter robotic system™ (Distalmotion), and furthermore assess the feasibility of this approach using this robotic platform.

Materials and methods: A 43-year-old woman with uterine adenomyosis and recurrent uterine prolapse underwent a robotic-assisted subtotal hysterectomy with cervicosacropexy, performed below the bikini line, using the Dexter robotic system™, at the Clinic of Gynecology and Obstetrics at Universitätsklinikum Schleswig-Holstein (UKHS) in Kiel, Germany.

Main outcome measures: Perioperative data, surgical approach specifics, objective, and subjective outcomes of this new approach.

Results: The procedure was performed without intra-operative complications; estimated blood loss was 10 ml. Operative time was 150 minutes, console time 120 minutes, total docking time 6 minutes. Dexter performed as expected; no device-related issues or robotic arm collisions occurred. The patient did not require pain medication and was released on the second postoperative day.

Conclusion: RAH performed below the bikini line using the Dexter robotic system™ is a feasible, safe, and adequate procedure. These initial results should be confirmed and further extensively refurbished with larger patient cohorts, and functional and psychological outcomes need further investigation.

Video scan (read QR)

https://vimeo.com/920372026/1c0f3ea89b