Multidirectional traction method using SURGICEL NU-KNIT® and surgical suture in robot-assisted laparoscopic surgery for endometrial cancer.

OBJECTIVE: To describe a novel approach to robot-assisted laparoscopic total hysterectomy (RH) for endometrial cancer (EC) that minimizes cancer sell spillage and develops a stable surgical field.

DESIGN: Demonstration of the multidirectional traction method with narrated video footage.

SETTING: Many reports have indicated that RH for EC has the same or superior short-term results compared to conventional laparoscopic hysterectomy (LH), and the long-term prognosis is the same (1,2). However, there are no randomized controlled trials of RH versus LH, and some previous reports (3) have suggested that RH has a worse prognosis than LH, so the long-term prognosis should be considered with caution. Factors that may affect the long-term prognosis include the use of uterine manipulators (4) and compression of the uterine body with robotic forceps without tactile sensation (3). However, to our knowledge, no surgical technique capable of avoiding these factors has been established yet. Herein, we report a multidirectional traction method using SURGICEL NU-KNIT® (ETHICON; Johnson & Johnson Medical Ltd., Tokyo, Japan), a local hemostatic agent, and surgical sutures.

INTERVENTION: Cut 2-0 PROLENE® (ETHICON; Johnson & Johnson Medical Ltd., Tokyo, Japan) with straight needles (ST-70) thread to 35 cm, and stick a 1 × 2 cm piece of SURGICEL NU-KNIT®, and make knots (figure 1). This implement is used to puncture the incisional margins of the peritoneum and then the abdominal wall to bring the thread to the surface of the body, where it is grasped with forceps and fixed. By repeating this operation, multidirectional traction can be obtained (Figure 2). A manipulating suture is also attached to the uterus to minimize the compression of the uterine body with robotic forceps.

CONCLUSION: The multidirectional traction method allows for reproducible stable surgical field development and minimizes cancer cell spillage by reducing uterine grasping by robotic forceps without the use of uterine manipulators.