Robotic Surgery in Gynaecology

Robotic surgery is a new innovation in minimally invasive surgery.  The use of robot assisted keyhole surgery in gynaecology has expanded due to technical advances.

 
The 3D vision provides greater precision compared to lap surgeries. The wristed instruments can be rotated 360 degrees and difficult areas can be reached.
 

It is an upcoming successful option that can treat an individual with less blood loss, less pain, less infection & reduced hospitalisation.
 

IT HAS MANY BENEFITS OVER CONVENTIONAL LAPAROSCOPY. Here a Surgeon operates from a computer console and his HAND MOVEMENTS are transmitted through the robotic arms to the patient. The 3D vision increases precision and magnification.
 

WHERE SHOULD WE BE USING THE ROBOT?
1. It is recommended in Complex Hysterectomy (Removal of Uterus) especially when a patient has multiple surgeries on her abdomen and she is Obese. Robot allows the surgery to be done by small cuts with more precision and Less pain.

 
2. MYOMECTOMY is a Procedure used to remove benign tumours from the uterine muscle wall (fibroid). Robotics allows better suturing post removal of the fibroid. Multiple fibroid and difficult locations can be reached and sutured well.

 
3. Endometriosis & fertility enhancing surgeries:
Endometriosis is a condition where tissues similar to the uterine lining grow outside the uterus. These tissues….. respond to hormones and bleed during period causing pain and adhesions. Surgical management of endometriosis is a challenge and requires operating deep in pelvis and pelvic side walls.
 

Removing a ovarian cyst on releasing the adhesion is more precise with Robot assisted endometriosis surgeries.

 
Many studies have shown fewer complication while operating in deep infiltrating endometriosis where there is lot of adhesions to bowel, bladder and ureter.

 
4. ROLE OF ROBOTIC SURGERY IN UROGYNAECOLOGY
It has an advantage in fixation of vault in vault prolapse post hysterectomy or in other cases where uterus has to be suspended. We need to use me she or suture to fix the displaced uterus or vault. Suture intense procedures can be done well.
 

5.   Laparoscopy is always a challenge in morbidity obese patients. They require longer instruments and good positioning. Wound healing also takes longer so keyhole surgery scores. Robotic surgery can reduce their morbidity and hospital stay.
 

LIMITATIONS
Cost of the robotic column and instruments are more when compared to laparoscopy. The maintenance also comes at a cost. The cost can be reduced once volumes are increased and newer robots enter the market.
 

INSURANCE companies should also approve the procedures.
 

Robot is the new kid on the block which has to be used judiciously.    The robot is considered a safe and effective tool in complex procedures. It will help reduce the number of open surgeries. It will reduce hospital stay and morbidies.
 

Dr Anuradha Panda
Consultant Obstetrician & Gyneacologist, Lap & Robotic Surgeon,
Apollo Cradle & Children’s Hospital, Jubilee Hills, Hyderabad.