Robotic Surgery – Gynecologic Applications

Hysterectomy Options

There are several options for hysterectomy surgery. The least invasive is a vaginal hysterectomy which involves the removal of the uterus through the vagina, without any external incision or subsequent scarring. Gynecologists most often use this minimally invasive approach if the patient’s condition is benign, when the uterus is normal size and the condition is limited to the uterus.

Gynecologists can also perform hysterectomies laparoscopically, in which the uterus is removed using instruments inserted through small tubes into the abdomen, resulting in three to five small incisions in the abdomen. One of these instruments is an endoscope—a small miniaturized camera—which allows the surgeon to see the target anatomy on a standard 2D video monitor. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy.

However, sometimes neither a vaginal nor laparoscopic hysterectomy is an option for some women, because of conditions such as large fibroids or multiple c-sections, which leave behind significant scar tissue.

In these cases, gynecologists have traditionally performed an open hysterectomy through a six to 12 inch incision in the abdomen. This type of surgery usually requires a four to six week recovery versus a 10 to 14 day recovery for a vaginal or laparoscopic procedure.

The New da Vinci Option

But now, surgeons can use the da Vinci Surgical System to perform a minimally invasive surgery on women who would normally require an open procedure, giving them the benefits of quicker recovery, fewer complications and reduced pain.

“The da Vinci system gives a surgeon significantly greater range of motion than a laparoscope,” says Frank Lake, Jr., MD, an OB/GYN with Heritage OB/GYN in Gainesville. “It requires less torque, which means I can turn corners better without having to push against other tissues; this helps minimize the pain to patients. Basically, if your wrist can do it, the da Vinci can do it.”

Other Gynecologic Applications

Additionally, the da Vinci has applications for other less common gynecologic surgeries, including myomectomies (surgical removal of fibroid tumors which leaves the uterine intact), abdominal sacrocolpopexies (surgical correction of vaginal vault prolapse, or falling) and surgeries to treat cervical and endometrial cancers.

“Because the da Vinci has wrist action capabilities, we are able to get around corners and in tight spaces,” says Andrew Green, MD, a gynecologic oncologist with Southeastern Gynecologic Oncology in Gainesville. “In certain procedures, this allows for a more aggressive cancer surgery in a minimally invasive manner with outcomes equivalent to open procedures. For example, using the da Vinci to remove the cervix in the treatment of cervical cancer takes far less time than the procedure would take laparoscopically, which means using less anesthesia, and it takes about the same amount of time as an open procedure, but with a shorter recovery time, fewer incisions and decreased chance of infection.”

“The da Vinci Surgical System has provided great advancements for gynecologic surgery and allows women more procedure options,” says Dr. Lake. “I would say to women that if you have been told you need an open abdominal gynecologic surgery, investigate your options with the da Vinci system, which may allow you to undergo a less invasive procedure.”

Like all new technology, robotic surgery is not appropriate for all patients. For more information about gynecologic surgery applications for the da Vinci Surgical System, call 770-219-3840.

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