title: Vaginal robot-assisted radical hysterectomy (VRARH) after laparoscopic staging: feasibility and operative results.
abstract: BACKGROUND
  To describe a technique of vaginal robot-assisted radical hysterectomy (VRARH) that utilizes the advantages of a robotic system and eliminates the manipulation of cancer tissue.
  
  
  METHODS
  A prospective study was performed for VRARH using the da Vinci robotic surgical system in 12 patients. The procedure was indicated in patients with cervical cancer stage FIGO IB1 after laparoscopic lymphadenectomy. A tumour-adapted vaginal cuff was created transvaginally.
  
  
  RESULTS
  All operations were completed with minimal blood loss (mean 123 ml). The mean operative time including para-aortic lympadenectomy was 356 min, the vaginal cuff creation took 43 min and the radical robotic resection 68 min. No uterine manipulator was used. There were no bladder or bowel complications and no conversion to standard laparoscopy or laparotomy.
  
  
  CONCLUSIONS
  The VRARH technique combines the advantages of the vaginal route and robotic laparoscopic surgery: tumour contamination is avoided and complications are minimized. This procedure could be superior to techniques described previously.
authors.affiliation: Department of Gynaecology, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Oleszczuk
authors.forename: Christhardt
authors.initials: C
authors.lastname: Köhler
authors.forename: Jeanette
authors.initials: J
authors.lastname: Paulick
authors.forename: Achim
authors.initials: A
authors.lastname: Schneider
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Lanowska
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000473:pathology / Q000601:surgery*