Surgical technique
The patient was placed in the lithotomy position. The abdominal surgery area was sterilized with Aner’s iodine, and the vulva and vagina were sterilized with iodophor. The surgical area was covered with operation towels routinely. We chose the position where about 3-4cm above the umbilicus as the approach location of the robotic camera port, and the camera port used a 12mm Trocar puncture cannula. An 8mm puncture cannula was placed through the intersection of the vertical line along the body axis along the left anterior superior iliac ridge and the horizontal line through the umbilicus, which served as the robotic arm 2 approach. The symmetrical point on the right side served as the robotic arm 3 approach. The middle point of the camera port and the arm 3 puncture position was the arm 1 entry port, and an 8mm puncture cannula was used. Similarly, we set a puncture approach used by a surgical assistant (Asst.) between the camera port and the arm 2 puncture port, which also used a 12mm cannula (Fig. 1C). Monopolar Curved Scissors were often used in arm 1, Fenestrated Bipolar Forceps in arm 2, and ProGrasp Forceps in arm 3. The assistant used atraumatic grasping forceps, curved forceps, or aspirator according to intraoperative needs. And the puncture positions of other departments were carried out based on their surgical habits (Fig. 1C, D, E, F). The number of puncture ports and surgical body position may change because of intraoperative needs (Fig. 1B).
On the basis of the patient’s primary diagnosis, the surgical procedures were performed according to surgical principles in NCCN guidelines and other medical standards. For example, for cervical cancer patients, radical hysterectomy with bilateral pelvic lymph node dissection were performed. And endometriosis patients were performed with endometriosis lesions excision. If metastases or complications occurred, the related non-gynaecological organs should be partially removed or completely repaired.