Peer-reviewed veterinary case report
Safe trocar placement in robotic endometrial cancer surgery
By Nagasawa T et al.·2026·Department of Obstetrics and Gynecology, Japan·View original on Europe PMC →
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Original publication title: Safe Trocar Placement by Transvaginal Endoscopic Insertion in Robot-Assisted Surgery for Endometrial Cancer With Umbilical Incisional Hernia and Prior Mesh Repair: Two Case Reports.
Plain-English summary
This study describes two women with endometrial cancer who also had issues related to their belly button area, either from a hernia or previous surgery. Because of their past surgeries, doctors were worried about complications if they used the usual method to insert surgical tools. Instead, they used a special camera inserted through the vagina to see inside the abdomen and safely place the tools. In one case, they found mesh and scar tissue near the belly button, while in the other case, they didn't find any scar tissue in the hernia area, but they did find some in a different spot. This approach shows that using direct visual assessment during surgery can be very helpful and safer than relying only on imaging tests.
Abstract
We report two cases of endometrial cancer with umbilical incisional hernia or prior mesh repair, in which robot-assisted surgery was safely performed using transvaginal laparoscope insertion. Both patients had prior abdominal surgeries, and preoperative imaging raised concerns about adhesions or mesh near the umbilicus, making conventional trocar insertion risky. A laparoscope was inserted via the posterior vaginal fornix, allowing real-time intra-abdominal visualization and safe port placement under direct vision. In one case, mesh and adhesions were confirmed at the umbilicus. In the other, no adhesions were found within the hernia sac despite being suspected preoperatively, whereas dense adhesions were identified at Palmer's point, which could not be fully characterized by imaging alone. These cases highlight the limitations of relying solely on imaging and underscore the utility of intraoperative visual assessment. Transvaginal scope insertion offers a simple, reproducible method to enhance trocar safety. To our knowledge, no previous reports have described this technique used solely for observation in robot-assisted surgery for endometrial cancer.
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Search related cases →Original publication on Europe PMC: https://europepmc.org/article/MED/41508785