by Michael Silverman, MD
Since the introduction of minimally invasive techniques for gynecologic surgeries such as hysterectomy, fibroid removal and endometriosis, a growing number of women have been able to avoid traditional “open” surgery and have a less invasive procedure such as a laparoscopy instead.
For the right candidates, such minimally invasive techniques allow for much smaller incisions rather than one large incision, fewer complications, less blood loss and scarring, and shorter hospital stays and recovery times.
In a standard laparoscopic procedure, we make several small incisions in the abdomen and place a tiny camera into one of them that projects images onto a video screen. We insert the surgical instruments through the ports and, guided by the images on the screen, perform the surgery.
In most cases, we can perform surgery successfully with standard laparoscopy. In some, however, certain factors such as the location or size of a tumor, the health of the patient and whether cancerous cells have spread to other areas may rule out standard laparoscopy. Often, these cases may be successfully treated with the da Vinci robotic-assisted surgical system.
Robotic-assisted surgery furthers improve laparoscopic surgery for gynecologic conditions in several key ways. First, unlike the single camera with one scope used in standard laparoscopy, the robotic camera is a binocular telescope.
This double-scope advantage provides remarkable 3-D resolution and a greater depth of field in the surgical area; in some cases, this enables us to perform procedures that we might not have had the visual ability to perform with the “naked eye” view of standard laparoscopy.
Second, the robotic instruments are more advanced than those in standard laparoscopy; essentially, they mimic the human hand and wrist and can be turned and rotated for better dexterity and precision. This maneuverability greatly expands our ability to perform surgery just as we would in an open procedure, if not better.
One example of this is radical hysterectomy, often recommended for the treatment of cancer or other gynecologic diseases; in fact, hysterectomy is the second most common surgical procedure for women in the United States.
Hysterectomy can often be done successfully through laparoscopy, and robotic-assisted technology has further improved it by enabling us to see more of the nerves that run through the tissues we are operating on that we couldn’t see with the standard scope.
We are now able to spare more of the nerves, and consequently, a decreasing number of patients appear to experience bladder dysfunction or need catheters after surgery. Moreover, because there is less pulling on the abdominal wall with the robotic instruments, patients may experience less pain as well.
Another example is endometrial cancer, or cancer of the lining of the uterus. This is the most common type of gynecological cancer; the standard treatment has been an open surgery not only to remove the diseased organs and tissue but also to determine how much the cancer has spread.
Robotic-assisted technology has enabled us to do a number of these surgeries laparoscopically with the same success rates and significantly less difficulty for the patient. The same is true of early ovarian cancers that have not spread beyond the pelvis.
In addition, robotic-assisted surgery is ideal for a number of non-cancerous gynecological conditions that are not life-threatening but may still cause chronic pain, heavy bleeding, infertility and other disabling symptoms; these include endometriosis, ovarian cysts, uterine fibroids, which are benign growths in the wall of the uterus, and a uterus that is falling or slipping (known as uterine prolapse).
While robotic-assisted surgery can be an excellent option in cases where standard laparoscopy is not appropriate, there are some limitations. Because it is so targeted, it may not be the best option in cases where the cancer has spread to a large area.
Also, patients who have lung problems, respiratory illness or cannot have general anesthesia may not be good candidates for robotic-assisted surgery. Finally, robotic technology is more expensive —although one may argue these costs may be offset by shorter hospital stays and faster return to work.
This Scripps Health and Wellness information was provided by Michael Silverman, MD, a gynecologic oncology specialist at Scripps Memorial Hospital La Jolla.