Wednesday, December 08, 2010
Posted by: Gary Burgoine, MD
As mentioned by Dr. Mukul in a previous post, minimally invasive surgery was introduced by gynecologists in the 1970s. It uses small incisions to insert instruments, including a tiny video camera called a laparoscope, that allow the surgeon to work inside the body. While initially used for simple “look and see” procedures and tubal ligations, surgical skill has advanced, aided by increasingly specialized instruments, to do more complex procedures. Still, the very nature of traditional minimally invasive surgery places some limitations on what can be accomplished, given the confined space within which the surgeon works and the limited view delivered by the laparoscope.
Robotic surgery, properly termed “robotic-assisted laparoscopic surgery,” is one of the most recent developments in minimally invasive surgery. While robotic surgery is similar to traditional minimally invasive surgery, there are a few important differences. First, the video camera that is inserted through a small incision to see inside the patient is much more sophisticated and gives the surgeon high definition, magnified 3-D vision of the surgery site.
Second, instead of manipulating the surgical instruments directly, the surgeon uses controllers in a nearby, high-tech console. A surgical robot is attached to the surgical instruments at the patient’s bedside and translates the surgeon’s movements into finer, smaller and more precise movements than are possible in traditional minimally invasive surgery.
The final key distinction in robotic surgery is that the surgical instruments that are attached to the robotic arms are “wristed” and can move with greater freedom and dexterity than the “straight stick” laparoscopy instruments used in traditional minimally invasive surgery. The wristed instruments have a greater range of motion than even the human hand. The short video below illustrates the dexterity of the robotic instruments in manipulating a very small object.
While this all sounds a little like science fiction, the robot cannot be programmed to make decisions or do anything on its own. Your surgeon still does all of the surgery. Think of the robot as a very specialized instrument that allows surgeons to offer the benefits of minimally invasive surgery to a greater number of people with more complex cases. These benefits include lower risk of blood loss and transfusion, lower risk of infection and faster recovery and return to regular activities. Often, people can have their surgery and leave the hospital the same day. In terms of gynecology, robotic-assisted surgery can be used to perform hysterectomies, surgery on the ovaries, myomectomies (procedures to remove uterine fibroids without a hysterectomy) and some pelvic support procedures to correct pelvic organ prolapse.
Surgery, like all of medicine, continues to change and provide new options and devices to improve the safety, satisfaction and outcomes for patients. However, not all problems can be treated with minimally invasive techniques and some patients have additional factors which make it a less ideal consideration. Talk with your surgeon about his or her experience treating your condition and what risks you might face. Ask about minimally invasive approaches and whether robotic-assisted surgery is an option for you.
Dr. Gary Burgoine is a board-certified OB/GYN physician and surgeon trained in minimally invasive surgery who sees patients at Women’s Healthcare Associates’ Tualatin campus.