Robotic Approach Broadens Options for Minimally Invasive Gynecologic Surgery

Points to remember

• When performed by experienced surgeons, robotic surgery overcomes some of the challenges associated with laparoscopic procedures.
• The robotic system provides 3-dimensional imaging and articulated instruments that enhance a surgeon's precision when navigating challenging anatomy.
• Mayo surgeons performed more than 400 gynecologic procedures in 2009 using the robotic approach, including hysterectomy, myomectomy, and correction of vaginal prolapse.

The challenge

Robotic gynecologic surgery, the most recent development in minimally invasive surgical techniques, offers many of the benefits associated with laparoscopic surgery. These benefits include:

• Decreased blood loss and transfusion requirements
• Fewer instances of postoperative infection
• Reduced postoperative pain
• Shorter hospital stays and recovery periods

Surgical robots can also help overcome some of the challenges associated with conventional laparoscopy by allowing surgeons to operate with more precision and flexibility.

Workstation console controls for robotic instruments

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Laparoscopic surgery poses some well-documented challenges because surgeons must rely on 2-dimensional imaging of the surgical field and learn counterintuitive hand movements. Robotic technology overcomes many of these limitations, using 3-dimensional visualization and highly maneuverable instruments that more closely mimic the direction and movement of the surgeon's hands.

While looking though binoculars equipped with a high-resolution 3-D stereoscopic imaging system, the surgeon manipulates controls inside a workstation console several feet from the operating table. These controls guide robotic endoscopic instruments docked at the operating table.

The surgeon's console has the master controls that relay the exact movements of the surgeon's hands and fingers to the instruments and filter out any hand tremor.

Focal infrahepatic metastatic ovarian tumor excision

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Minimally invasive robotic surgery

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The surgical instruments are equipped with articulating tips and wrist mobility that improves precision. This sensitivity enhances a surgeon's ability to navigate challenging anatomy, to deftly perform microresection, and to precisely place sutures.

Surgical indications

When performed by experienced high-volume surgeons, the robotic approach provides an effective option for a wide range of patients.

At Mayo Clinic, gynecologic surgeons now use the robotic system to perform many complex gynecologic procedures, including hysterectomy, cancer staging operations, myomectomy (especially when preserving fertility is a goal), and correction of vaginal prolapse.

The robotic surgery option has proven effective for patients who require hysterectomy due to both benign and malignant conditions, including cervical and endometrial cancer. Additionally, robotic technology offers a minimally invasive surgical option for patients in whom vaginal hysterectomy is contraindicated by obesity or other factors. Patients who in the past traditionally required a large incision for gynecologic surgery for various reasons may now take advantage of the benefits associated with minimally invasive hysterectomy.

Although operative and anesthesia time using the robotic system can be slightly longer than those associated with traditional laparotomy and laparoscopic approaches, a dedicated team of Mayo Clinic surgeons have developed a surgical technique to optimize operating time using the robotic system. With fewer wound complications, an average hospital stay of 1 night, and patients' resumption of most normal activities within 2 weeks following surgery, the robotic approach to gynecologic surgery is quickly becoming a preferred option for many patients.