Introduction/Background Robotic approach to radical hysterectomy appears to facilitate precise dissection in pelvis. LACC trial and several retrospective studies demonstrated inferior survival of patients undergoing radical hysterectomy for cervical cancer via laparoscopic approach as compared to laparotomy. Concerns for lack of proper oncologic technique during laparoscopic cases arose with findings of unusual metastasis sites like omentum, peritoneum, and trocar sites.

Methodology Surgical videos from patients undergoing robotic nerve sparing radical hysterectomies for cervical cancer and for colorectal cancer metastatic to the uterus.

Results We demonstrate our modifications to robotic nerve sparing radical hysterectomy technique (adaptation of Okabayashi method). Puppeteer technique is used to provide countertraction without utilization of uterine manipulator. Stapler is used to transect vagina, allowing for en-block resection without tumor exposure to instruments and peritoneal cavity. Final specimen’s bath and cytology provide quality control. Bladder insufflation, ureteral ICG injection and vaginal methylene blue, facilitate dissection, possibly decreasing chances for ureter devascularization.

Conclusion Robotic nerve sparing radical hysterectomy is a difficult and meticulous procedure that requires an experienced surgical team. It can be performed with strict adherence to oncologic principles. Future studies on laparoscopic or robotic approach to radical hysterectomy should include tumor spillage and nerve sparing quality controls as well as long term survival and quality of life assessments.