Rachel Spieldoch, MD
Surprisingly, nearly two thirds of hysterectomies are still performed in America with open laparotomies. However, it has been proven through multiple studies that minimally invasive surgery with laparoscopy has been shown associated with a faster recovery, lower infection rates, shorter hospitalization stay, decreased blood loss as well as significantly less postoperative pain when compared to traditional abdominal surgery.
In gynecology, laparoscopy has become a valuable tool for performing multiple surgeries including: hysterectomy, ovarian surgery, myomectomy (uterine fibroid removal), endometriosis, and pelvic floor procedures for vaginal prolapse. It has additionally become an adjunct for many surgeries in reproductive endocrinology and infertility as well as in gynecologic oncology. While laparoscopy has many indications in gynecologic surgery, there are limitations which include restrained instrument motion and dexterity, the use of 2-dimensional visualization, as well as significant surgeon fatigue related to ergonomically unfavorable positioning.
The da Vinci robotic system was approved in 2005 by the Food and Drug Administration and has revolutionized minimally invasive surgery. Robotic assisted laparoscopic surgery overcomes many of the limitations found with traditional laparoscopy. This allows for more complex surgical cases to be performed with minimally invasive surgery. In fact, removal of fibroids with robotic surgery allows for removal of larger fibroids and been shown to have even less blood loss than when performed with traditional laparoscopy.
The da Vinci robotic system is comprised of three components. The first component is the surgeon’s console which is located near the patient bedside. The surgeon is seated at the console and controls the robot assisted tools which include the camera and all surgical instruments. The second component is the called the patient-side robot. The surgical instruments are attached to the patient side-robot which are placed carefully within the operative field. Third, the vision cart allows for 3-dimensional imaging. Finally, a surgical assistant is at the patient’s side throughout the procedure for additional aid. In order for all components of the da Vinci robotic system to orchestrate, a well-trained surgical team is required.
As with any surgical advancement and technique, it is crucial to balance available technology with its indications for use and potential advantages. The da Vinci robotic system offers instruments which have full dexterity and range of motion. The 3-dimensional visualization and the ability to quickly zoom into small areas allows for precise tissue manipulation in challenging surgical spaces. This is unique to robotic surgery. As a result, the robotic instruments are superior for delicate tissue manipulation and dissection. This may be of particular use in patients who have had scarring from previous surgeries, endometriosis, malignancy, uterine fibroids or other similar situations. These advancements with robotic surgery gives experienced surgeons the opportunity to offer patients minimally invasive surgery which in any other circumstance would require an open laparotomy and large abdominal incision.
From the surgeon’s perspective, the robotic system also allows the operator to sit comfortably at a console. This helps to avoid physician fatigue due to standing for long hours in uncomfortable positions. Furthermore, the capabilities of the robotic system are astounding with regards to medical communication and teaching! Imaging, such as a recent CT scan or MRI can be seen on the surgeon’s console. This may be helpful when trying to precisely locate an abnormal finding such as uterine fibroids. Additionally, the system allows specialists who are long distances away from the actual surgery to watch the procedure and communicate with the operating surgeon. This aids in providing up-to-date techniques and improved patient care.
It is important that patients consult with their physician regarding the best surgical method to deal with their medical concerns. While minimally invasive robotic surgery has many advantages, it may not be the most appropriate surgical option for everyone. However, one thing is for sure, robotic surgery is continually offering exciting advancements to minimally invasive surgery and it is here to stay!