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.