For women considering surgery to treat disorders affecting the female reproductive system, robotic-assisted surgery with the da Vinci system has become an increasingly popular treatment option. Da Vinci’s robotic technology enables surgeons to carry out a number of minimally invasive gynecologic procedures with high accuracy and precision, using very small incisions.
 

Understanding Gynecologic Conditions

Gynecologic disorders are medical conditions affecting a woman’s reproductive organs and structures in the abdominal and pelvic area, including the uterus, ovaries, fallopian tubes, cervix and vagina. Most women will experience at least one gynecologic disorder during their lifetime.
 
These disorders tend to cause one or more of the following symptoms: severe pain in the lower abdomen; abnormally severe menstrual pains; vaginal bleeding; vaginal discharge; a lump protruding from the pelvic floor; weight loss and/or other menstrual cycle irregularities, such as increased or decreased blood flow, or in some cases, a missed menstrual period despite not being pregnant.
 

Gynecologic Surgery Techniques

Medications and other non-surgical treatments may prove effective for treating gynecologic disorders. In other cases, surgery may be the best option. Doctors typically have three types of surgical techniques to consider:
 

• Open (conventional) surgery, which requires a relatively large surgical incision and potential cutting of layers of skin, tissues and muscles. Compared to less-invasive methods, recovery from open surgery takes longer due to the more extensive physical trauma and the larger incision wound

 

• Laparoscopic surgery, a form of minimally invasive endoscopic surgery whereby a laparoscope — a thin tube-like tool with a tiny camera and light on its tip — is inserted through a small incision in the abdomen. The technique results in minimal physical trauma; nearby tissues, organs and structures are unaffected, minimizing pain and potential surgical complications such as blood loss and infections. Patients who undergo gynecologic laparoscopic surgery tend to recover faster than those treated through open surgery

 

• Robotic-assisted surgery with the da Vinci system, a technique designed to improve surgical efficiency, accuracy and safety, particularly for highly complex procedures involving difficult-to-access surgical sites. The typical incision (and resulting scar) for this type of surgery is similarly small as it is with gynecologic laparoscopic surgery

 

Suitable Conditions

Robotic-assisted surgery using the da Vinci system is increasingly favored for treating the following gynecologic conditions:
 

• Uterine fibroids
• Gynecologic cancers such as uterine, cervical and ovarian cancers
• Ovarian cysts and tumors
• Endometriosis
• Perineal membrane disorders
• Infertility
• Sacrocolpopexy, a surgical treatment for prolapse of the vaginal vault, a condition affecting women who have had a previous hysterectomy
• Chronic abdominal pain

 

Robotic-assisted Surgery: The Process

Robotic-assisted gynecologic surgery typically involves the following general process:
 
1. Pre-surgery preparations: Patients are normally admitted to the hospital the day before the surgery. The pre-surgery examination will include checking blood pressure and blood glucose levels; analysis of the balance of fluids and minerals; and carrying out protective measures to reduce the risk of infection. Patients are usually required to abstain from eating or drinking for at least eight hours prior to surgery to prevent food particles being ingested into the lungs.
 
2. As surgery begins: After anesthesia is administered, the patient is fitted with an endotracheal tube for ease of breathing. The surgeon will inflate the abdomen with carbon dioxide, which increases the space for the surgical area and ensures the surgeon has a clear, unobstructed internal view. The robotic arm is located beside the patient’s bed, and the surgeon controls the movements for insertion of the laparoscope and other surgical devices through four small surgical incisions in the abdomen. The surgeon sits at the da Vinci control console a few feet from the patient and performs the surgery using the 3D internal images that the camera attached to the robotic arm transmits back to the console in real time and with very high clarity.
 
The da Vinci system sends signals from the surgeon’s hand movements in real time to move the robotic arm using exactly the same movements made by the surgeon. Once the internal surgery is finished, equipment such as the laparoscope is removed, and the surgeon does the suturing of the incision.
 
3. Post-surgery considerations: For most robotic-assisted gynecologic surgeries, patients typically stay two or three nights in the hospital before returning home. The doctor will determine whether any dietary restrictions are necessary; for example, eating only bland foods for a certain period of time. And doctors typically have patients return for a follow-up examination about one week after surgery to assess recovery and healing progress.
 

Risks and Complications

Through millions of patient surgeries, robotic-assisted surgery using the da Vinci system has built an excellent safety record since its introduction nearly 20 years ago. All surgeries, whether open, laparoscopic or robotic-assisted, come with some level of risk of infection, bleeding or anesthesia-related complications. They occur infrequently and are usually not serious in nature. Your doctor will discuss the potential risks and complications of any surgical procedure you are considering.
 

The Benefits of Robotic-assisted Surgery

Robotic-assisted surgery offers an array of potential benefits, including:
 

• High levels of safety, accuracy and precision resulting from the surgeon being able to view high-resolution 3D images of the patient’s internal organs and structures

 

• Greater surgical flexibility due to the robotic system’s range-of-motion capabilities. The robotic arm can be extended and flexed in seven directions, compared to four directions for laparoscopic surgery. Robotic-assisted surgery also can reach tight spaces more easily than human hands or devices used in laparoscopic surgery

 

• Da Vinci’s anti-vibration system keeps the surgeon’s hands steady, enabling greater accuracy compared to other methods

 

• Because it is a type of minimally invasive surgery, surgical incisions are very small. This can translate to reduced blood loss; less scarring; less pain and swelling; and fewer wound infections or other post-surgery complications

 

• Patients enjoy faster post-surgery recoveries, so hospital stays may be shorter, and normal activities can resume more quickly than would be possible with other surgery methods

 

Talk to Your Doctor

If you are considering gynecologic surgery, it is important to talk to your doctor to understand the potential benefits, risks and possible complications for each available surgical treatment option. This will help in making an informed decision based on your individual situation.
 
 
By Dr. Chantawat Sheanakul, an OB/GYN specializing in gynecologic oncology and minimally invasive surgery at the Women’s Center, Bumrungrad International Hospital.