Robots in Surgery

Dr. Rachel Yankama – VoiceAmerica: A Doctor’s Guide to Robotic Surgery

Are robots in surgery just a fad?  Or,  will it revolutionize medicine  and general surgical practice?  Robots are being used to make surgery that was previously done through large incisions now possible with much smaller incisions.   In gynecology,  laparoscopic surgery actually set the stage for expanding the utilization of smaller incisions.   Sterilizations,  removal of ovarian cysts,  ectopic pregnancy,   removal of small fibroids were the initial uses and for diagnosis of chronic pelvic pain with treatment of endometriosis.   Since then uses have expanded to include the general surgeon’s realm of appendectomy,  gallbladder removal, and bariatric surgery.    More recently, gynecologists have expanded the use of laparoscopy to include hysterectomy as well,  and gynecological oncologists are using laparoscopy to do lymph node dissections for cancer surgery for uterine,  cervical  and ovarian cancer.       Of course the benefit of having surgery  (if you have to have surgery) through smaller incisions is that there is significantly less blood loss,  hospital stays are shorter,  there are fewer infections,  and postoperative pain is significantly less.  Plus, most people are back to work a lot earlier as well.

So how does the robot fit in with all of these advances?  For one thing,  the robot is connected to the laparoscope and provides a 3-D picture for the surgeon as compared to 2-D on the traditional laparoscopy.    Secondly the surgeon controls the robot “arms”  and “hands” to move the equipment in the direction desired.   With traditional laparoscopy the movements of the equipment in the body are the opposite of what the surgeon’s hands are doing outside the body.  Thirdly,  there is a certain amount of magnification which makes it easier to cauterize blood vessels to prevent excess bleeding.   And finally,  the robot makes suturing so much easier to perform in comparison to traditional laparoscopic suturing.  For hysterectomies,  this is known as the DaVinci Hysterectomy.
So overall there  are a lot of benefits to the person having robotic surgery.   Smaller incisions,   faster recuperation,  less pain medication after surgery so therefore less trouble with constipation from the pain medication,   also  there is less blood loss,  and shorter hospital stays  resulting in lower chance of getting  an infection.   However,  with the good side there are also potentially some complications which are part of the fact that it is a laparoscopic procedure,  and that includes a  potential injury to the bowel,  bladder, or to a major blood vessel.   In addition,   specifically for laparoscopic hysterectomy there are reports of the vagina not healing well after surgery and breaking down at a later date.  This may require emergency surgery to fix.  This does NOT happen very frequently.

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