Introduction
Robotic-assisted surgery, which was originated in 1994, has become one
of the favorite surgical approaches adopted by surgeons. Da Vinci
Surgical System (Intuitive Surgical Inc.), which was classified as a
master-slave surgical system, was approved by the United States Food and
Drug Administration (FDA) in 2000 for general laparoscopic surgery and
in 2005 for selected gynaecologic procedures1. After
that, Da Vinci surgical system rapidly developed its application areas
in gynaecologic surgeries, and even created single-site
form2. It was indicated that the most common
indications for robotic-assisted surgeries consisted of intricate
hysterectomy, sacrocolpopexy, bladder and ureter injuries repair, deep
infiltrating endometriosis, gynaecologic cancer staging surgeries and
recurrent pelvic tumors resections3-5. In addition, Da
Vinci system could provide 3D vision, distinct amplified view, flexible
endo-wrist facilities, visual immersion tremor filtration and
appropriate ergonomic design3, 6. So that blood loss,
intraoperative and postoperative complications, operation and recovery
time could be reduced significantly, especially in obese or elderly
patients7, 8. It was no exaggeration to say that
robotic-assisted surgery has brought tremendous revolutions to minimally
invasive therapy, especially in gynaecology.
A multi-disciplinary team (always abbreviated as MDT) is a
patient-centered medical service pattern. It is a process in which
senior experts from multiple disciplines formulate a personalized
diagnosis and treatment plan for specific patients through joint
discussions or cooperative operation, and it is especially suitable for
the diagnosis and treatment of complex diseases such as tumors, severe
systemic trauma, and multiple organ failure. MDT is a creative diagnosis
and treatment pattern widely respected in the modern international
medical field9, 10. It not only improves the quality
of medical treatment, but also effectively forms the collaboration while
breaking the barriers between disciplines, and realize the improvement
of doctors, departments and hospitals. More and more literature linked
the quality of teamwork with the quality and safety of medical services.
And the MDT pattern has also been widely used in obstetrics and
gynaecology.
A British research institute conducted MDT assessment on 200 patients
with ovarian tumors, and found that the sensitivity of discovering
ovarian cancer increased to 98.4%11. Researchers from
University of Manchester in the United Kingdom also carried out an MDT
pattern for 41 patients with advanced ovarian cancer, and believed that
the four key parts of the MDT implementation were: clinical
presentation, patient factors, chair’s direction, and input from other
specialties12. MDT pattern shows advantages in the
diagnosis and management of intractable diseases. At the same time, MDT
could also play a certain role in the formation of personalized surgical
treatment. Some researchers have found that the combination of
laparoscopic score and MDT pattern can complete more satisfactory tumor
cytoreductive surgery for recurrent ovarian cancer, for the survival
time is significantly better than those with chemotherapy alone or with
cytoreductive surgery that has not been evaluated and performed by
MDT13. Scholars from Taiwan have also found that
patients with peritoneal cancer could
have greater opportunities to achieve thorough operation due to the use
of tumor cytoreductive surgery and intraperitoneal hyperthermic
perfusion combined with the MDT pattern14. It was also
reported a case of a 73-year-old woman suffering from cervical clear
cell carcinoma using the MDT pattern to develop a diagnosis and
treatment plan15. In fact, MDT is not only used for
gynaecological malignant tumors, but also for non-malignant diseases in
obstetrics and gynaecology. Some evidence revealed that MDT could be
used in disseminated uterine leiomyomas, severe placental implantation
and the management of hyperthyroidism during
pregnancy16-18. Besides, MDT was often associated with
deep infiltrating endometriosis19, 20. Therefore, the
MDT pattern was expected to be applied to all aspects of the diagnosis
and treatment in obstetrics and gynaecology. However, it was still
difficult to find some research that shared the experiences of using the
MDT pattern in the robotic-assisted gynaecological surgery.
Since 2006, DaVinci Surgical System has been introduced to Chinese PLA
General Hospital and has created a new era of precise surgeries. There
are several professors from different disciplines who can accomplish
robotic-assisted laparoscopic surgery perfectly, so that chances of
organizing MDT operations were gradually increasing. Our research will
summarize the characteristics of the patients who have undergone
robotic-assisted MDT gynaecological surgeries in Chinese PLA General
Hospital from 2018 to 2021 to discuss the details of this pattern.