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Robotic Surgery Offers More Options for Reproductive Procedures

by Leigh Ann Woodruff, July 16, 2012

Robotics technology is definitely the way of the future, but in the here and now, it is already changing the way many surgeries are performed, some of which are reproductive surgeries. The technology offers reproductive endocrinologists a way to perform operations for conditions such as fibroids or endometriosis with a minimally invasive approach while offering enhanced visualization and the ability to repair reproductive organs for fertility that an open surgery offers.

What Is Robotic Surgery?

The technology for robotic surgery was created by the U.S. army during the 1980s and was then sold to Intuitive Surgical, which designs and builds the da Vinci® surgical systems. The technology — which includes a console where the surgeon sits and operates, a surgical tower with the robotic "arms" and a video tower — was approved for use in gynecologic surgery in 2005.

"Anything that can be done laparoscopically or as an open procedure can be done better robotically," says Sejal Dharia Patel, M.D., a fertility doctor with the Center for Reproductive Medicine in Orlando, Florida. "It's a different method of access with unique advantages."

Before robotic surgery, surgical options were typically limited to traditional "open" surgery or laparoscopy, which uses a thin, lighted tube put through smaller incisions. The minimally invasive laparoscopy is often used for simpler procedures.

Robotic surgery combines the benefits of both open procedures and laparoscopy with a minimally invasive approach for complex procedures. With robotic surgery, the surgeon's hands control the instruments in the robot's arms while the surgeon sits at a console and performs the procedure using an enhanced, three-dimensional image, in contrast to laparoscopic surgery, which is a two-dimensional image. The surgeon has greater range of motion and a better ability to make repairs that can preserve a woman's fertility.

"The surgeries that we tend to do robotically are the complex surgeries — ones that are usually not done laparoscopically," Dr. Patel explains. "Laparoscopically, you don't have the same range of motion when you're operating as you do with an open surgery. Laparoscopically, we can do perform tubal ligations, remove scar tissue, remove cysts from the ovary, but with a tubal reversal where you are using microscopic sutures, or myomectomies, where you are suturing extensively, it becomes more challenging. As we are dealing with a reproductive-age population, we want a more precise approach, which can be accomplished robotically. You have 7 degrees of freedom, magnified vision and an immersive environment — all of which allows for a more consistent and successful outcome."

Procedures that May Use Robotic Surgery

Some of the procedures that may be performed with robotic surgery include:

  • Surgical tubal reanastomosis. Tubal reversal for a woman who has had a tubal ligation but desires future fertility.
  • Myomectomy. Removal of uterine fibroids.
  • Endometriosis surgery. Resection of endometriotic lesions.
  • Scar tissue and adhesion removal.
  • Repair or reconstruction of congenital anomalies. These can include such things as uterine septum and bicornuate uterus.

"What [robotic surgery] has done is allow us to be much more aggressive surgically," says Dr. Patel, "meaning that if a patient had myomas in the past, most surgeons, to close the uterus effectively would have considered an open myomectomy. Robotic surgery has enabled us to perform the same open procedure in a minimally invasive way."

Advantages of Robotic Surgery

Robotic surgery is a more expensive way to perform surgery than laparoscopy, which is why it is generally reserved for the more complex surgical cases that for which a surgeon would perform a traditional, open procedure. "If a procedure can be performed laparoscopically, there's no reason to use robotic technology," Dr. Patel says. "Laparoscopy is a more cost effective way to perform the procedure. But if you're going to have to do an open surgery, then the patient can be provided with a minimally invasive approach. I think that there's incredible value there for the patient."

The surgeons use tiny incisions and can operate with greater precision and control. What does this mean for patients? Pain is minimized, as is the risk associated with large incisions. "A patient who has an open myomectomy has about an 80 or 90 percent chance of having remaining scar tissue," says Dr. Patel, "whereas someone undergoing robotic myomectomy has a 30 to maybe 40 percent chance of scar tissue formation postoperatively."

Robotic surgery has the same advantages as laparoscopic surgery, such as faster healing, less pain, fewer complications and less scarring. "The advantages for the patient: She comes in the morning, has a robotic myomectomy, goes home in the afternoon and is back on her feet within a few days and is back to work within a week or two weeks," Dr. Patel says. "Faster recovery for the patient and a minimally invasive approach.

"Patients should be really proactive if they need surgery to find an experienced surgeon," Dr. Patel continues. " And it would be ideal for them, if applicable, find the most minimally invasive approach."

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