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Robotic surgery is the safest option for gynecological procedures

Robotic surgery is the safest option for gynecological procedures

Many gynecological diseases need to be treated by surgery. However, in the past, every woman with abnormal bleeding had surgery to remove the uterus (hysterectomy) as the only treatment option.

When we talk about benign diseases, such as fibroids, adenomyosis and endometrial polyps, there are hormonal treatments and surgeries that preserve the uterus. But when hysterectomy is inevitable or even other important gynecological surgeries, such as deep endometriosis, where fertility may be at stake, we have advanced technology with many advantages: robot-assisted surgery.

The surgical robot is a computerized device controlled by experienced medical surgeon that can be programmed to assist the positioning and manipulation of surgical instruments. The equipment consists of a console that functions as a control base, in which the main surgeon is seated manipulating the arms of the robot remotely. The purpose of the robot-assisted laparoscopic surgery is to help surgeons improve care by making the procedure more accurate with less blood loss,

The team consists of at least two medical surgeons: one will be in the console and another in the surgical field, assisting in what is necessary and available for any emergency. In addition, the team includes the anesthetist physician, instrumentator and nurses specialized in robotics. In most cases, the procedure also involves two or three other surgeons.

The first time robotic surgery was used was in 1985 in neurosurgery, then in urology and orthopedics. Today the main areas they use are gynecology, urology and general surgery.

Robotic surgery is usually indicated for procedures previously performed only by videolaparoscopy. In gynecology, the main indication is hysterectomy and surgery for deep endometriosis. Since the 1980s, surgical robots have been developed to overcome the limitations of laparoscopy, such as 2D visualization, incomplete articulation of instruments and limitations of surgeon position. The goal of robot-assisted laparoscopic surgery is to help surgeons improve care by making the procedure more accurate, with less blood loss, better recovery, and earlier discharge.

Robot-assisted laparoscopic surgery has all the advantages of surgery minimally invasive by videolaparoscopy, including minor postoperative pain, minimal incisions, shorter hospital stay, shorter recovery time and faster return to work, adding even more precision and greater comfort to the surgeon, while also increasing patient safety.

Among the advantages we can mention the possibility of remote surgery. The technology allows the primary surgeon to be in another room, in another hospital or even in another country. Of course, there will always be a full medical team in the patient's presence, but it is possible to expand the possibilities of treatment by taking advantage of the experience that lives elsewhere, for example.

The major advantages of the robot over conventional laparoscopy are:

Better visualization of the operative field by the main surgeon: three-dimensional (3D) versus two-dimensional (2D)

  • Mechanical improvements: Robotic instruments have seven degrees of freedom, similar to human arm and hand, while conventional rigid laparoscopy instruments have only four degrees of freedom. Although there are already newer flexible laparoscopic instruments that move in seven degrees, movements with these instruments are not intuitive as the movements performed with the robot and their use may require more advanced training.
  • Stabilization of instruments within the surgical field : In conventional laparoscopy, small movements by the surgeon are amplified (including errors or hand tremor). In robot assisted surgery, the tremors are minimized
  • Better ergonomics for the surgeon, who works sitting comfortably on a console. Approximately 8 to 12% of surgeons report pain and numbness in the arms, wrists or shoulders after conventional laparoscopic gastrointestinal surgery.
  • Among the disadvantages of robotic surgery are:

Additional surgical training

  • Increased costs and operating room time
  • Instrumentation Limitations: There is not yet a full range of laparoscopic instrumentation for robotic surgery. That is why not all procedures that can be performed by laparoscopy can be done by robotic
  • Risk of mechanical failure, but that can also happen in conventional laparoscopy. There are several mechanical controls and balances available in robotic systems, so the risk of mechanical failure becomes less than in conventional laparoscopy.
  • Therefore, it is important to know that this technology already exists and is available in some centers in our country. The main barrier to having more robots operating is the cost of both the equipment and the training of the medical and nursing staff in the technique.

I must emphasize that robotic surgery brings many gains for the care of patients with endometrial cancer and in surgeries of withdrawal of the uterus from benign diseases such as fibroids and adenomyosis. The gain is also enormous for endometriosis, where great care is needed to preserve tissues to avoid pelvic pain and infertility. The accuracy gained with the robot can and is already helping us deliver better results for women with endometriosis. Further studies are needed to evaluate these results, but we are optimistic.


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