What is robotic surgery?
Robotic surgery is the most technologically advanced type of minimally invasive “key-hole” surgery. The da Vinci Surgical System is the pioneer robotic surgical system made by the American company Intuitive Surgical. It uses advanced robotic technologies to assist the surgeon with an operation.
It does not act on its own. Movements of the robot arms are controlled by the surgeon who sits in a console in the operating room.
The tower, which is positioned directly over the patient during surgery, contains the robot arms – three that can hold a variety of specially designed miniaturised surgical instruments, and a fourth that holds the system’s HD 3-D camera. These arms are controlled by a computer that exactly replicates the movements of the surgeon.
The console is where the surgeon sits and operates the robot’s controls while looking into a monitor that provides a magnified (up to 10x) HD 3-D view of the surgical field. The surgeon manipulates the robot’s arms by manoeuvring two master controls that provide fingertip precision of movement.
What gynaecological surgery is done using the robot?
Robotic surgery may be utilised for many complex gynaecological operations such as hysterectomy surgery, removal of fibroids also known as myomectomy. removal of ovarian cysts or excision of endometriosis. As robotic surgery offers enhanced vision, accuracy and dexterity, it allows more variety of complex procedures to be performed in a minimally invasive way.
Hysterectomy may be recommended for treating a variety of conditions including:
Removal of the ovaries are not usually recommended in most non-cancerous cases. All surgery presents risk, therefore hysterectomy should be a last resort when all other treatments have failed.
Hysterectomy may be performed through open incision on the abdomen, vaginally or laparoscopically “key-hole”. Robotic hysterectomy is a type of laparoscopic hysterectomy.
A vast majority of hysterectomies can now be safely performed robotically. If you have been recommended to have an open incision on the abdomen for non-cancerous cases, ask your doctor or gynaecologist for another opinion if this can be done through robotic surgery.
What is involved in robotic surgery?
Robotic surgery is performed under general anaesthetic in a hospital.
Four to five small 8-10mm incisions are made on the abdomen to allow insertion of 3-4 miniaturised surgical instruments and a magnified HD 3-D camera. These are mounted on robotic arms. The surgeon is able to control these arms by placing his fingers into the master controls in a console located in the operating room.
Every movement he makes with the master controls is replicated precisely by the robot. All four arms of the robot can be simultaneously controlled while the surgeon is looking through a HD monitor that literally places him inside the patient, giving him a better, more detailed 3-D view of the operating field.
Women usually stays in hospital for 1-2 nights after a robotic hysterectomy (compared to 4-5 nights after an open surgery). Recovery is also quicker, usually in 2-3 weeks (compared to 6 weeks after open surgery).
Why robotic surgery? What are the advantages over traditional laparoscopic or open surgery?
Robotic surgery instruments are designed to provide surgeons with natural dexterity while operating through small incisions. Modelled after the human wrist, they offer a greater range of movements than the human hand, allowing greater precision in an operation.
Compared to open incision surgery, robotic hysterectomy allows:
- less pain
- less blood loss during operation
- lower risk of infection
- lower risk of formation of clots in legs (deep vein thrombosis) or lungs (pulmonary embolus) after surgery
- less scar tissue formation
- and quicker recovery.
What are disadvantages of robotic surgery for gynaecology?
Robotic surgery system is more expensive to run and there is limited access to the robotic system and expertise. Almost all the robotic system in Australia are available only in private hospitals. However, the availability is increasing with time, and the cost is also coming down as there are more new systems coming to the market.
