Wachyu Hadisaputra
Division of Reproductive Health Department of Obstetrics and Gynecology Medical Faculty of Indonesia University/ National General Hospital Dr. Cipto Mangunkusumo Jakarta

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Laparoscopic Robotic Surgery in Gynecology Wachyu Hadisaputra
Indonesian Journal of Obstetrics and Gynecology Volume. 35, No. 3, July 2011
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Objective: To know the development and application of robot assisted laparoscopy in gynecology. Method: Literature review. Result: Laparoscopy procedure has been widely used since the last three decades where minimally invasive surgery cases and demands increase in urology, cardiac surgery, general surgery, and particularly, gynecology. To date, laparoscopy has developed into robot-assisted laparoscopy due to needs of precise dissection of delicate structures, procedures which requires sophisticated technique, and surgeon’s fatigue through the laparoscopy procedure. There are three robotic system which are commercialized and had been approved by FDA: AESOP, ZEUS, and Da Vinci, the latest robotic system which is used worldwide nowadays. There are advantages of robotic systems and conventional laparoscopy to open surgery laparotomy, such as diminished morbidity rate; less esthetical incisions; decreased post and intra operative blood loss, postoperative pain, use of pain medication, less cosmetic problems, and shorter length of hospital stay. Advantages of robotic surgery compared to conventional laparoscopy and laparotomy; include improved dexterity, more precise and accurate articulation, reduced tremor and surgeon’s fatigue, and better visualization of the operating field because of 3D image. Robotic system has drawbacks such as limited area of surgery field in trocar-placing to avoid collision of the robotic arms, longer operative time, and a higher cost. Conclusion: The major drawback of robot-assisted laparoscopy is in the term of cost; because of the high cost of robotic system; which could be overcome by a lower morbidity rate, less incisional aesthetic problem, less total intra operative blood loss, decreased demand of analgesics post operative, and shorter length of hospitalization stay and recovery time; as compensation of the high cost of robotic system. Further researches to study about the learning curve of robotic laparoscopy to achieve a faster operative time are needed. A longer operative time in robotic system can be anticipated with accurate simulation training in robotic system. There is also a need for further researches to discuss the total peri-operative cost. [Indones J Obstet Gynecol 2011; 35-3: 146-50] Keywords: laparoscopy, robotic system, robot-assisted, Da Vinci system, learning curve, gynecology
Adhesion Prevention in Operative Laparoscopy Wachyu Hadisaputra
Indonesian Journal of Obstetrics and Gynecology Volume. 34, No. 4, October 2010
Publisher : Indonesian Socety of Obstetrics and Gynecology

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Objective: To know the modalities used for prevention of adhesion formation in operative laparoscopy. Method: Literature study. Results: Methods of prevention of adhesion in laparoscopy include: modification of surgical technique, anti-inflammatory agents, peritoneal instillates and barrier adjuvants. Modification of surgical techniques such as adherence to basic principles of microsurgery, the use of electrothermal bipolar vessel sealer, liberal irigation of the abdominal cavity and instillation of a large amount of Ringer’s lactate at the completion of the procedure. This technique alone, eventhough seems effective, is insufficient. The anti-inflammatory agents used are the NSAIDs, corticosteroids, antihistamines, progestogens, GnRH agonists and calcium channel blocker. But none of them demonstrated to be significantly effective. Barrier adjuvants consist of: oxidized regenerated cellulose (ORC) and expanded polytetrafluoroethylene (ePTFE) and peritoneal instillates are the crystalloids, icodextrin, hyaluronic acid (HA), solution of HA, viscoelastic gel, hydrogel, and fibrin sealent. There is insufficient evidence data regarding the methods above for the prevention of adhesiogenesis in laparoscopy. But one study evaluating the use of viscoelastic gel did significantly reduce adnexal adhesion in laparoscopy. Conclusion: Laparoscopy does not trully eliminate the adhesiogenesis problem. No single therapy is effective for prevention of adhesion formation. The multimodal methods shall be used to increase the successful rate in adhesion prevention. [Indones J Obstet Gynecol 2010; 34-4: 204-7] Keywords: laparoscopy, adhesion, microsurgery, anti-inflammatory, peritoneal instillates, barrier adjuvants