Robotically-assisted Laparosopic Ovarian Cystectomy Using the Lumenis FiberLase CO₂ Fiber and the Drop-in Guide

Michael Scheiber, MD

The procedure described is a highly effective technique to surgically treat extensive pelvic endometriosis, adhesions, and endometriotic ovarian cysts. It is a reproducible technique with a fast learning curve, making it a widely available technique for all gynecologists who are trained and experienced in the use of robotically-assisted laparoscopic surgery and the treatment of endometriosis. Since the CO₂ laser penetrates just micrometers in the tissue, we used the laser when the risk of injury for nearby structures was high as well as to reduce the risk of collateral damage to normal surrounding tissue that is often seen with cautery. Having the opportunity to use the fiber and the drop-in guide simplified the procedure since it was easier to control the direction of the laser compared to the free beam, and the fiber also produces less smoke. In addition, the drop-in guide allows the surgeon to take significant advantage of the degrees of freedom of movement of the robotic “wrists,” allowing easy access to locations that would be almost impossible with a straight port or the free beam. Finally, using the CO₂ laser for treating endometriosis is characterized by easily reproducible techniques and good clinical and fertility outcomes. Using the robotic drop-in guide and the CO₂ laser to treat significant endometriosis provides a safe and easily reproducible technique allowing good clinical outcomes. In addition, potential reduced harm to the ovaries and surrounding delicate tissues during laser surgery (versus extensive cautery) may possibly increase the chances of fertility preservation.

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