Nerve-Sparing Robotic Radical Hysterectomy for the Beginner in Robotic Surgery.

Robotic surgery is considered to be the optimal means of performing nerve-sparing radical hysterectomy (RH) because this procedure requires very precise surgery. Nerve-sparing RH has become increasingly popular in Japan. However, with open surgery the operating field is only visible to the surgeon performing this delicate procedure, which makes it difficult to educate trainee assistants. However, robotic surgery provides an expanded operation field that is visible to the surgeon and assistants, which makes it suitable for teaching purposes. To perform this procedure, it is necessary to become proficient in RH by laparotomy and then to become familiar with the characteristics of robotic surgery. In shifting from laparotomy to robotic surgery, we have found that experience with open surgery does not fully prepare surgeons for the new experiences and discoveries associated with robotic surgery, which may initially be problematic. We here provide clear instructions for the procedure with notes concerning particular potentially problematic aspects.