Robotic surgery in Gynecology

The introduction of da Vinci robotic surgery to the field of gynecologic surgery has made minimally invasive procedures a possibility for a growing number of patients for whom open surgery was once the only option.

Indeed, conventional laparoscopy has been beneficial when compared to open surgery with advantages such as shorter hospitalization, faster recovery, less blood loss, better cosmesis and fewer complications. However, laparoscopy as well as surgical approaches via the vagina [ where the abdomen does not have to be cut open ] have limitations when there is complex surgery to be done. Both the vaginal approach for Gynecological surgeries as well as laparoscopy can also be challenging because of limited operative field visualization and the requirement for a skilled surgical assistant.

The turning point came in April 2005, once the FDA approved Robotic technology for Gynecologic surgery. Since then the adoption of robotic surgery has been rapid. Several hospitals have reported a decrease in both open hysterectomies and traditional laparoscopic surgeries while the rate of robotic surgery increased dramatically.

In fact it would not be wrong to say that Robotic surgery has completely revolutionized surgical care of women. Technologic advances such as EndoWrist instruments that mimic natural hand and wrist motions intuitively, much like open surgery, not only offer an ergonomic advantage to the surgeon, but the increased precision of surgery because of three-dimensional vision and EndoWrist instrumentation reduces complications and overall surgical time.

The surgeons proficiency, the efficiency of the operating room, and surgical outcomes have all certainly been positively impacted by robotics.

Some Gynecological surgeries that are performed using Robotic technology are:

• Hysterectomy, an operation to remove the uterus. A woman may have a hysterectomy for different reasons, including:
  • Uterine fibroids that cause pain, bleeding, or other problems
  • Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
  • Endometriosis
  • Abnormal vaginal bleeding
  • Chronic pelvic pain
  • Adenomyosis, or a thickening of the uterus
• Myomectomy, a surgical procedure to remove uterine fibroids. The surgeon’s goal during myomectomy is to take out only the fibroids and reconstruct the uterus. Unlike hysterectomy, which removes the entire uterus, myomectomy removes only the fibroids and leaves the uterus intact.
• Sacrocolpopexy, is surgery done to correct Pelvic prolapse, a condition that occurs when muscles and ligaments that support the pelvic organs such as the uterus, vagina, cervix, bladder, urethra, or rectum weaken and make these organs slip from their normal position.
• Radical hysterectomy, for cancer of the cervix or endometrium where the surgeon removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina.
• Surgery for complex endometriosis, Endometriosis is a disorder in which the tissue that forms the lining of the uterus grows outside the uterine cavity.
• Tubal anastomosis, a procedure to restore fertility after a woman has had a tubal ligation – a procedure that cuts or blocks the fallopian tubes to prevent pregnancy.