09 May Robotic Surgery in Gynaecology
Why all the fuss about robotic surgery?
Robotic surgery has been hailed as the next generation of minimally invasive surgery by the marketing machine of Intuitive Surgical – maker of the only available surgical robot system – da Vinci robot. Thousands of gynaecological procedures have been performed using this robot. Most data indicate that robotic gynaecological surgery is not more superior than the traditional laparoscopic ‘keyhole’ surgery, and is more costly to the health budget. So, why would you choose robotic surgery?
What is Robotic Surgery?
Robotic surgery is a type of laparoscopic ‘keyhole’ surgery, albeit with more advanced and expensive instruments – 3D HD magnified view of the surgical field, and wrist like articulation of instruments such as graspers and scissors. Its superiority may not be appreciated in a ‘standard’ hysterectomy of a normal sized uterus in a patient of a healthy weight. Patients with an enlarged uterus and those that are overweight, however, exhibit more difficult anatomy and it is in these cases that the surgeon and patient will reap the most benefit from the superiority of the robotic instruments and vision. Here, robotic surgery provides patients with an option to have minimally invasive surgery when they would otherwise be limited to an open approach (laparotomy).
An analogy is found in an article that recently compared performing laparoscopic surgery to driving a car. Why drive a Rolls Royce (robot) when you can drive the same road and reach your destination in a Volkswagen (traditional laparoscopy)? This may be true for a road that is straight and flat, on a fine clear day. But, if the road is windy and bumpy, and the rain is pouring down, you’d want to be in the Rolls Royce! In fact, if you can afford a Rolls Royce, wouldn’t you choose this for your journey every day?
Intuitive Surgical has been monopolising the market ever since they pioneered the technology. There are now a number of competitors entering the market in the next couple of years, and this will inevitably drive the cost of the robots and surgery down, thereby improving accessibility. Most major private health funds are already covering the cost of robotic surgery in private hospitals, and eventually, more affordable robots will lead to accessibility in the public system too.
In this era of fast paced, high impact marketing, it is easy to forget that the robot is just a surgical instrument. The term ‘robotic’ is often misleading. Robots don’t perform surgery. The surgeon or gynaecologist performs the surgery with the robot by using instruments that he or she guides via a console. Regardless of which route or instrument you and your surgeon has chosen, it is more important that your surgeon has done the surgery multiple times with their chosen instrument, and that they are confident they are delivering the best outcome for you. It is much more important that the driver (surgeon) is a safe driver who is familiar with his or her car, and has travelled the journey many times before.