Printer-friendly format

We have now entered the new realm of robotic gynecologic surgery. It’s been about 30 years since the laparoscope changed the practice of surgery, and with the introduction of the robot in gynecologic cases, we find ourselves breaking new ground once again. We can thank our urology colleagues for popularizing these new robots for prostate surgery. In addition, several other medical specialties, including cardiothoracic and orthopedic surgeons are now embracing its virtues.

In gynecologic robotic surgery, the goal is to transform the exploratory laparotomy into a minimally invasive, same-day surgery. Some of the advantages to the patient include fewer days in the hospital, potentially fewer nosocomial infections, less blood loss and a more precise surgery due to magnified three-dimensional optics. The robotic laparoscopy has been described as an “enhanced” or “dramatically improved” laparoscopy. Analogous to traditional laparoscopy, special trocars must be placed through the abdominal wall and the robot must be “docked” into position. A third robotic arm can be used, which significantly enhances proper positioning of internal structures to help facilitate surgical goals. The surgeon then sits comfortably at a console across the room from the patient performing the “telesurgery” via finger, hand and foot controls as a qualified assistant for irrigates/aspirates, passes suture or changes instruments.

For the surgeon, the robotic approach removes hand tremor and decreases fatigue. Utilizing the robot’s “clutch” mechanism allows the surgeon to place sutures or incise areas that might be more challenging with traditional laparoscopic techniques. A myriad of graspers, cautery, cutting and suture needle driving instruments delivered through a flexible “robotic arm”, improve dexterity as compared to traditional laparoscopy.

As with the description of any surgical advantages, we must also note the disadvantages to the robotic approach. Utilizing the DaVinci robotic surgical instruments requires the attaching or “docking” of the robotic arms to the laparoscopically placed trocars. This takes approximately 20 to 40 minutes of operating room and general anesthesia time. Robotic procedures require specially trained operating room staff, and the instruments must be replaced after a defined number of uses. The instruments are expensive to replace and the surgery also requires a custom “draping” of the robot, which also adds to the bottom line. In short, there are real concerns regarding OR time and costs.

The Gynecologic-Oncologists are utilizing robotic surgery to transform complex cancer staging surgeries--traditionally lengthy midline incisions–to minimally invasive endoscopies. In my realm of infertility surgery, with robotics, we are able to perform myomectomies, complex pelvic endometriosis and adhesions cases as well as tubal sterilization reversal cases via same day surgery. No doubt this technology is here to stay and I look forward to embracing its ability to improve patient care.

Dr. Samuel E. Brown, a local board-certified infertility specialist with the Center for Reproductive Medicine



September 2007

Tags:

None

Login and voice your opinion!