Recently I spoke with a family member about robotic surgery and I was surprised to see what little she knew about this important topic in modern gynecology. Her impression was comical; a robot out of a science fiction movie yielding a scalpel in some sort of space ship operating room. The truth is that robotic surgery has a lot less to do with a robot and a lot more to do with providing a very specialized tool to the operating surgeon.
Laparoscopy and minimally invasive surgery began over 100 years ago with the idea that small incisions can be made in the body to introduce a camera and diagnose disease. In the 1980’s laparoscopy gained significant popularity thanks to new instruments that allowed the surgeon to operate efficiently. Using long thin instruments through small tubes called trocars, surgeons were able to perform movements with varying degrees of precision. This allowed for complex surgeries such as hysterectomies and even cancer resection.
Despite advancements, traditional laparoscopy is limited. Although a surgeon’s hand can turn and swivel thanks to our wrists, rigid laparoscopy instruments are limited to only one angle. This is a major problem in patients with difficult anatomy. These patients would typically be offered traditional open surgery that involved large incisions.
Robotic surgery involves the use of a surgeon controlled tool to perform highly advanced laparoscopy. The surgeon still makes small incisions and places trocars as they would in traditional laparoscopy. However, the surgeon introduces instruments that are able to articulate even better than a human wrist and fingers. The result is a remarkable improvement in precision.
The physician controls every movement of the robot “hands” through movements of his or her own hands. Visualization is enhanced via a magnified high definition 3D screen. Safety mechanisms include hand tremor control and freezing of instruments when the surgeon looks away from the screen. The robotic system functions like a surgeon’s shadow; unable to perform independent movements.
The advantages of robotic surgery are well documented and include short hospitalization, minimal pain, and rapid return to daily activities. Also, the psychological benefit of small cosmetically pleasing scars cannot be underestimated.
Our practice has been using the da Vinci robotic system for several years with great success. We perform almost all major surgeries robotically; especially cases that in the past would require a large incision. Often time, patients requiring major surgery would postpone treatment indefinitely due to concerns of a lengthy recovery; tolerating symptoms such as chronic pain and bleeding. Now those same patients seek us out to see if they are candidates for minimally invasive robotic surgery.
Ernesto Cardenas MD, FACOG
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