Is Robotic Surgery right for me?
The introduction of the da Vinci robot-assisted surgery for use in gynecologic surgery in the past few years has been of great benefit to many patients. It allows the use of a minimally invasive laparoscopic route to cases that would otherwise require an abdominal approach. In the field or reproductive surgery, this benefit most frequently pertains to the removal of uterine fibroids. In the past, the majority of fibroids could only be removed through laparotomy, or a large open incision. But with the use of robotic surgery, the vast majority of these procedures can be performed laparoscopically. This offers the patient a huge benefit. What usually required a 2-3 day hospital stay and 4-6 week recovery is now an outpatient procedure, with the patient going home the same day, and able to return to work in 7 days. There is significantly less blood loss, and less scar tissue formation around the uterus. Surgical outcomes are equal to those performed through an open procedure. With such great benefit, I strive to not perform on open procedure on patients. Even in very difficult settings, nearly all cases can be performed laparoscopically. The only cases which I consider laparotomy instead of a minimally invasive surgery is in those cases with large numbers of fibroids (more than 10), though even with large numbers, select cases may be robotic candidates. Fibroid size is not a limitation.
Another condition that can benefit from the use of robotic assistance is that of severe endometriosis. Particularly in the setting of pelvic pain, it is essential to remove all of the endometriosis. This can be done by standard laparoscopy, but if other organs such as intestines are involved, most surgeons under-treat the disease due to fear of injuring surrounding critical organs. Few surgeons treat it adequately due to the extended amount of time that such a surgery can take. The use of the da Vinci robotic system allows me to more thoroughly treat the disease, and perform a much more careful dissection around critical organs, and do all of this much faster than can be done by standard laparoscopy.
For women facing a hysterectomy, the use of robotic assistance allows for the performance of much more surgically challenging cases. These involve large fibroids, fibroids in difficult locations, endometriosis, and scar tissue. Well more than 90% of abdominal hysterectomies could and should be performed through a minimally invasive route.
You may ask, if this is of such benefit, why isn’t the procedure being done more often? There are several answers to this question. Many times, with general gynecologists, the patients aren’t truly given informed choices of their options. They are usually given the options that their physician can perform, but less often are they given other viable options. Many gynecologists lack the skills and/or training necessary to perform advanced laparoscopic surgery. Unfortunately, they often fail to consider what is in the best interest of the patient, as that may mean referring that patient to an advanced laparoscopic surgeon. Often, the patient may not know all of her options, or be told by the physician that it is not an option. These are situations in which doing your homework or seeking a second opinion can benefit you.
Is the robot necessary for these more difficult cases? No, as most of these above mentioned surgeries can be accomplished by a skilled laparoscopic surgeon. But with increasing complexity, comes the need for more advanced surgical skills, and longer operative times. To a skilled surgeon, the robot does expand what can be “easily” be done laparoscopically, which allows for a faster surgery, improving patient recovery.
If you might be facing a difficult surgery, and question whether the use of robotic assistance may benefit you, please call to arrange a meeting or phone consultation with Dr. Duffy