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Robotic gynecology surgery: Dawn of a new era or a passing fad

Kenneth CK Leong, Melbourne, Australia | Wed, 04/14/2010 2:43 PM
From the earliest moment in mankind's history, surgery played an important role in the management of many ailments. In its earliest roots, surgery was crude, ineffective and often deadly.
Thus, at that time, the foundation on which the treatment of many ailments depended on was inaccurate and unsurprisingly ineffective.
In the twentieth century, further advances in surgical instrument design, radiology and imaging technology permitted more accurate diagnosis and allowed for more effective surgical treatment.
In the late twentieth century, survival from complex surgery became a daily occurrence.
Whilst surviving surgery is now the norm for most surgical procedures, the recovery process is often painful, debilitating and protracted.
Open surgery for removal of uterus, appendix or gallbladder is often performed through a substantial cut on the abdomen.
This approach was the only way until the arrival of tiny cameras and long narrow instruments inserted through small holes made in the patient's body.
Henceforth, minimally invasive surgery or "keyhole" surgery arrived.
Surgeons could peer into body cavities inspecting internal organs through small man-made holes or natural orifices. With successive improvements in keyhole surgical instruments, surgeons cannot only visually diagnose diseases but can also actually start to manipulate and operate on diseased tissues.
Minimally invasive surgery allows patients to recover much quicker from the ordeal of surgery because this type of surgery is less traumatic.
Furthermore, patients suffer less blood loss, experience lower infection risks and recover much quicker.
However, conventional keyhole surgery is not perfect because the instruments used are rigid and inflexible with limited range of movements. The operating stance of the surgeon and his assistant are ergonomically poor.
Come the da Vinci Surgical System. It is the future of gynecology surgery. This system consists of three components: the surgeon console, the patient sidecart, and the 3-D vision system and stack.
The surgeon sits at the console several feet away from the patient and looks down into the eyepiece, visualizing the operating field with immersive 3-D vision.
The surgeon's operating hands are positioned directly in front of the surgeon's vision in perfect eye-hand alignment akin to open surgery. The surgeon operates the controllers, which move the operating instruments loaded onto the patient sidecart. The operating tips of the instruments move with precision and pinpoint accurately without tremor inside the patient's abdomen and pelvis.
Because the operating tips are wristed with 7 degrees of freedom, the instruments can simulate fine hand movements. The major advantages are more precise dissection, even less blood loss, decreased complication rates and reduced postoperative pain. This results in a better operation, shorter hospital stay and quicker recovery.
For hysterectomy (removal of uterus) and myomectomy (removal of fibroids) cases, most patients are discharged from the hospital the next day and by the end of the two-week period, they would return to normal daily activities.

However promising the da Vinci Surgical System is, it comes with a hefty price. However, if one considers the savings in early hospital discharges, less need for pain relievers, and early return to work, the justification for its use becomes even more compelling.
The da Vinci system is beneficial in other surgical disciplines such as urology, heart valve surgery, ear, nose and throat surgery, general surgery and bowel surgery. In gynecology, it is used for hysterectomy involving cancer and benign tumors of the womb, reversal of blocked tubes, and pelvic organ prolapse surgery.
As a surgeon, the more complicated the surgery and the larger the patient, the more one benefits from using the robot because such patient would previously need to be operated on by open surgery.
These patients are often not in the best of health to withstand open surgery and are more likely to develop postoperative sepsis and thrombosis.
Since large surgical wounds are avoided, pain control required after robotic gynecology surgery is often much less and if needed, simple painkillers would usually suffice.
Gynecology procedures are the most commonly performed operations using the da Vinci Surgical System.
By the end of 2009, over 200,000 cases of hysterectomies were performed. Seventy five percent of these cases are for benign problems.
Technological advancement in robotic surgery has seen more sophisticated instruments developed to push the envelope of minimally invasive surgery. A prototype now exists for single port surgery using one operating instrument inserted through a small hole.

Advanced robotic surgery has caused a paradigm shift in the practice of surgery. This technology brings considerable benefits to patients but at a considerable cost. Notwithstanding the obvious upfront and running costs, there is a tri-fold advantage to this techno-logy:
savings for the overall health system and economy from early hospital discharges, quicker recovery, and less absenteeism
Robotic surgery is here to stay! Future innovations in robotic surgery will bring greater benefits for future patients.
Dr. Kenneth CK Leong is Robotic Gynecology Surgeon, IVF and Infertility Specialist in Melbourne Victoria, Australia. Articles in this column, which appears every two weeks, are provided by a panel of doctors from www.flyfreeforhealh.com, with services of health travel research, second opinion, global collaborative care & home health. Join free online seminar titled "Smoking in Pregnancy" on April 20, 2010 at 12 p.m. WIB. Register your email address by SMS to +65 98473224 to receive the link invite. Email us at info@flyfreeforhealth.com.

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