MDNews - Cleveland-Akron-Canton

+++++++++++++++++++++++++++++++++++++++++++ + + +++++++++++++++++++++++++++++++++++++++++++ SPECIAL SECTION: WOMEN’S HEALTH  +++ +++ Robotic Gyn Surgery Delivers Distinct Advantages By Albert T. Domingo, MS, MD modern age of minimally invasive surgery (MIS), which is generally safer and more precise than traditional open procedures. Today, however, there is a new S approach to MIS that is evolving rapidly, particularly in Northeast Ohio. The use of robots in the operating room — which is, in many ways, an extension of laparoscopy — is taking gyn surgery to new heights. Of course, this is not about technology for technology’s sake. It’s about providing better care, faster recovery and better quality of life for patients while signifi cantly decreasing post-operative pain and incidence of complications. When comparing the robot’s 3D view to the traditional 2D laparoscopic view during myomectomies, hysterectomies and other procedures, it is easy to see how robotics deliver distinct advantages — namely, remarkable visual acuity and a panoramic view of the pelvis together with state-of-the-art instruments that articulate from 180 to 360 degrees with ease. Hysterectomy and the related adnex- ectomy have been at the forefront of robotic gyn surgery, but the technology also makes elimination of fi broids and adhesions much simpler, as shown in this case study: A patient with adhesions who already had an ovary and a tube removed was very concerned about her ability to get INCE THE LATE 1980s, lapar- ascopy has been the standard of care in gyn surgery, and rightfully so. It ushered in the pregnant. In the past, laparoscopy would have been used to take out as many adhesions as possible with the hope that this would improve the chance of conception. Instead, through robotic gynecologic surgery, many adhesions in the cul de sac and right adnexal regions were eradicated with very little blood loss. A chromotubation on the remnant tube revealed a blockage, which was then opened using tools controlled from the robotic console. This increased the likelihood of conception tremendously. The surgery itself took less 30 minutes, and the patient was ready to go home about four hours later. Although the length of the sur- gery itself is brief, much time and care must be taken with preparation. Approximately 30 to 45 minutes is required for anesthesia, extremity protection, immobilization and inser- tion of ports before docking the robot and commencing surgery. That’s why it is essential to have a team of nurses and assistants who are trained in robotics. Successful preparation and surgery depends on it. What’s critical with robotics is that outcomes remain consistently good. With minor procedures, most patients go home within four to six hours. Hysterectomy patients may be kept overnight for monitoring, antibiotics, DVT prophylaxis and pain control, although much of this treatment is also available in the home setting. Soon after discharge, telephonic case management is used to monitor progress until the 40 | Cleveland-Akron-Canton MD NEWS  MDNEWS.COM  JULY-AUGUST 2011 patient’s two-week follow-up appoint- ment. Many return to work and other activities of daily living in just seven days. The completion rate with robotic gyn surgery is very high. On rare occasions, procedures may need to be halted, but that’s usually due to excessive scar tissue and adhesions from previous surgeries. Surgeons are also having good success with large uteri — even up to 22 weeks in size. Plus, controlling blood loss gets better with practice. When fi rst starting with robotic procedures, it’s not uncom- mon for a surgeon to lose about 75 cc of the patient’s blood. Over time, most are able to reduce the loss to 10 cc and under. Much of this improvement is due to the clarity of the visual fi eld. One challenge with robotics centers on smoke evacuation. Smoke cannot be evacuated too quickly, or the gap in the abdomen decreases. Then, operation is not possible. Insuffl ation of the abdomen is key. Robotic surgery is certainly here to stay. Its ongoing evolution is remark- able. Lasers can now be used for removal of fi broids, Covidien V-Loc sutures for fast closure of the vaginal cuff and robotic sacrocolpopexy to correct uterine and vaginal vault prolapse. As this extraordinary technology matures, more and more advancements that will benefi t many patients will continue to be developed. Dr. Albert Domingo is an ob/gyn who has performed more than 250 robotic gynecologic surgeries at Mercy Medical Center, where he is medical staff president. n

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