Minimally invasive surgery has revolutionized surgical care for a wide range of gynecologic conditions. For many women, this has meant less pain, shorter hospital stays and faster recovery time. Robotic surgery has added greater precision and control during gynecologic procedures, and its use has grown.
In this video, Scripps OB-GYNs Anupam “Bobby” Garg, MD, and Valerie Gafori, MD, join San Diego Health host Susan Taylor to discuss common gynecologic conditions that can be treated with surgery, including uterine fibroids, pelvic organ prolapse and endometriosis.
They explain minimally invasive gynecologic surgery, how it is different from traditional open surgery and the advent of robot-assisted surgery. The gynecologic surgeons cover the risks and benefits of robotic surgery, including robotic hysterectomy.
Millions of women suffer from severe pain in their pelvic area. “It is one of the more common complaints we hear about in gynecology,” Dr. Gafori says.
Surgery is an option when medication and noninvasive procedures are unable to provide relief for a gynecologic condition, including the following:
Endometriosis happens when the lining of the uterus grows outside the uterus. About 11 percent of women in the United States have endometriosis, according to the US Department of Health and Human Services (HHS).
Pelvic organ prolapse happens when the pelvic muscles and tissues supporting the pelvic organs weaken and become loose. When they can no longer support these organs, one or more can drop or press into or out of the vagina. Pelvic organ prolapse affects nearly 3 percent of US women, according to HHS.
“It’s more common after menopause and in people who’ve had multiple childbirths,” Dr. Gafori says.
Uterine fibroids are tumors, usually noncancerous, that grow in the wall of the uterus. Treatment depends on the symptoms. Fibroids become more common as women age, especially during their 30s and 40s through menopause, according to the HHS.
“Fibroids can cause problems with fertility,” Dr. Gafori adds. “Sometimes they need to be removed before someone tries to get pregnant.”
Fibroid tumors that return or fail to shrink after menopause are cause for concern, she explains.
“Fibroid tumors are typically hormone dependent. In menopause, your hormone levels go down. It’s concerning to have fibroids growing at this point. It can be a sign of a cancerous growth, such as sarcoma,” she says.
Other gynecologic conditions that can be treated with surgery are adenomyosis, pelvic inflammatory disease and ovarian cysts.
Minimally invasive surgery is a surgical procedure that is performed through small incisions. It is less invasive or damaging to the body, compared to open surgery, which is performed through larger incisions. Smaller incisions are made because surgeons don’t need to use their hands to directly access the body. This minimally invasive approach is generally associated with less pain, shorter hospital stays and fewer complications.
Laparoscopic vs. robotic
Minimally invasive procedures have several names, including laparoscopic surgery or laparoscopy and robotic surgery. Laparoscopy was one of the first types of minimally invasive surgery.
In a conventional laparoscopy, the surgeon makes one or more small incisions in the abdomen. The surgeon inserts a tube through each opening. The surgeon puts a tiny two-dimensional camera called a laparoscope and surgical instruments through those openings and operates.
“Laparoscopic surgery is an excellent surgery. It’s something we still frequently use,” Dr. Garg says. “But it has limitations in terms of how much range of motion you have and how much instrumentation you have available.”
In robotic surgery, a specially trained surgeon uses a computer console that displays a high-definition view of the surgical site. The surgeon makes small incisions using the small robotic arms, which are fitted with tiny surgical instruments and a minuscule three-dimensional camera.
“The computer translates our movements into smaller, more precise movements with the robot,” Dr. Gafori says.
The surgeon performing the procedure has the benefit of 3D visualization, Dr. Garg adds. “And that makes such a huge difference for hand eye-coordination.”
Hysterectomy is surgery to remove all or part of the uterus. It is a very common procedure. One in three women in the United States has had a hysterectomy by age 60, according to the Centers for Disease Control and Prevention. Today an increasing number of hysterectomies are minimally invasive surgical procedures, including robotic hysterectomy.
For fibroids, which can regrow after they are removed, a hysterectomy is the only permanent cure. For women of childbearing age who want to be able to get pregnant, a myomectomy is another option. “It is the least amount of surgery possible, which is just to remove that tumor,” Dr. Garg says.
Robotic surgery offers several potential benefits. Less pain, less scarring and less blood loss during the procedure. This results in lower risk of complications, shorter hospital stays and faster recovery.
“The recovery time is where the maximum benefit is,” Dr. Garg says about robotic surgery. “With open surgery, most patients will stay in the hospital for up to four days for a routine recovery. For robotic surgeries, most of our patients go home the same day.”
“With open surgery, the return to work can be four to eight, even 12 weeks. With robotic surgery, most patients can go back within two or three weeks,” he adds.
Any type of surgery comes with potential risks, including robotic surgery. “Every surgery has potential risks, such as infection and other complications,” Dr. Garg says. “However, studies show lower rates of complications when robotic surgery is in the hands of highly skilled surgeons.”
Not everyone is a candidate for minimally invasive surgery. Certain conditions still require traditional open surgery. “For example, if the uterus is very large or if someone has had a lot of previous surgeries,” Dr. Garg says.
Not everyone who is a candidate for minimally invasive surgery is suited for robotic surgery.
“We try to reserve the robotic surgeries for patients who have a little bit more complicated situation,” Dr. Gafori says. “We typically do a laparoscopy for a normal tubal ligation or to remove a small cyst.”
But in general, there is no overall set rule for who can and cannot get it. “It really comes down to that individual evaluation,” Dr. Garg says.