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Robotic surgery in Gynaecology

Robotic surgery is an advanced technology, which enables surgeons to perform laparoscopic surgery with better magnification, precision and dexterity. It helps in minimizing some of the difficulties encountered while doing laparoscopic surgery in gynaecology and helps to complete the surgery without resorting to open surgery.

Dr Neena Singh

The Da Vinci Surgical system (robot) is used to perform the followings minimally invasive surgical procedures in gynaecology:

  1. Hysterectomy
  2. Myomectomy
  3. Gynae Cancers
  4. Benign Conditions like Endometriotic Cyst of the Ovary and Dermoid Cyst
  5. Infertility / Tubal block surgery
  6. Fallopian Tube Reversal Recanalization
  7. Utero – Vaginal Prolapse correction
  1. Hysterectomy:  Hysterectomy is a procedure involving surgical removal of the uterus. Surgery is performed using finger tip size incisions.

The symptoms of Hysterectomy can differ from person to person, but the common symptoms are

  1. Fibroids
  2. Abnormal excessive menstrual bleeding
  3. Uterine or cervical cancer
  4. Endometriosis and Adenoneyosis

One can opt for robotic hysterectomy than the traditional one as it gives better results. In patients having frozen pelvic and immobile uterus of endometriosis or adhesions the 3D visualisation helps to delineate the uterus with great ease, dissection is blood less and operations becomes easier. So, a nightmare surgery becomes a cakewalk.

    2. Myomectomy: Myomas are tumours arising from the muscle of uterus. Myomectomy refers to the surgical removal of these myomas also known as fibroids. In contrast to hysterectomy, the uterus remains preserved in this surgery and the woman retains her reproductive potential.

The symptoms are

  1. Heavy bleeding during period
  2. Pain during period (Dysmenorrhoea)
  3. Infertility as a result of fibroid impingement
  4. Pelvic pain
  5. Pressure symptoms like difficulty in passing urine and stools
  6. Backache

Benefits of Robotic Myomectomy:

Awkwardly placed tabloids like posterior wall fibroids, cervical fibroids are removed with great ease because of the 3D vision, 4 robotic arms, effective energy sources and dexterity of the robotic wrist movement.

Not only is the removal easy but suturing is brilliant. One can do multiple layer suturing – 3 layers suturing for better haemostasis and for better strength of wound hence enhancing fertility.

Multiple fibroids are removed at one sitting with minimal blood loss, which is an exceptional event.

    3. Gynaecology Cancers and Pre-cancers:

Namely

  • Cancer Cervix
  • Cancer Uterus
  • Cancer Ovaries

Robotic laparoscopic surgery is particularly beneficial for cancer patients because of the advantage of 3D vision wherein removal of tumour tissues and lymph nodes becomes easier and complete. Robotic radical hysterectomy is benchmark in gynaecology surgery and widely accepted all over the world without the benefits of minimally access surgery with better precision.

Through this surgery the duration of surgery is cut shorter because of better vision, stability at the operating field, dexterity of the robotic wrist.

  1. No drains resulted in P.O. period because of precise lymph node dissection and easy mobilisation is a possibility.
  2. Visualisation of ureters and anatomy detailing is far superior to see and dissect safely.

Overall safety and recovery time is remarkably shortened.

    4. Infertility / Tubal block surgery: It is Inability to conceive after one year of unprotected relationship.

Robotically rectifiable causes are:

  1. Uterine fibroids
  2. Congenital malformations of uterus
  3. Tubal block because of pelvic infection
  4. Tubal block because of previous conservative treatment of ectopic pregnancy
  5. Ovaries cyst including dermoid or benign / malignant cyst tumours
  6. Ovaries endometriosis
  7. Adhesions in pelvis distorting utero-tubal-ovaries relationship because of tuberculosis or other pelvic infections or because of previous surgeries

Through this surgery complex surgeries become simplified and the operative time is reduced which makes patient recover fast.

    5. Utero Vaginal Correction:
  • Surgery is performed using finger tip sized incisions.
  • The uterus or upper vaginal wall (vaginal vault post surgery) slips down from its normal position and is called as utero vaginal prolapsed / vault prolapse respectively. This operation involves the insertion of a piece of material (mesh) with the aim of holding the uterus / vaginal vault in place.
  • Prolapse happens because of multiple child birth or prolonged labour or delivery of large babies through vaginal route or connective tissue disorders.

Benefits:

The mesh requires multiple sutures to the vault or uterus, which are applied in very less time and better precision, so better results.

Robotic Gynaecological Surgery is a technically advanced surgery, giving benefit to the patient and surgeon. As for patients concern

  • The surgery can be performed with better precision because of the 3D vision.
  • Suturing is much better than human hand as robotic wrists have dexterity and suturing can be done at any place with greater ease and precision resulting in better strength to the wound.

Beneficial for surgeons because time consuming surgeries can be performed without any fatigue which means quality surgery for patient. Hence, Robotic Surgery has made complex surgeries simple and better.

5 Comments

  1. DR SUNIL DHAR DR SUNIL DHAR Saturday, May 5, 2012

    I strongly feel marketing such robotic surgeries is just another way of making fast buck by those who claim to be experts in such procedures.
    We should not forget that India is counted as one the countries whose health care delivery system for a commoner is an apology.
    How many can afford these robotic surgeries? It is big business for corporate /private hospitals,who aggressively promote such hyped techniques.
    Unfortunately we do not have strong regulatory mechanisms in India ,unlike most of the countries.Doctors can get away with things literally unmolested.The culture of capitalizing on human sufferings reeks in corridors of most of the Corporate/Private hospitals.
    I strongly refuse to believe that systems such as Da Vinci sold in India do not come with freebies for doctors recommending/approving them. After-all, all exotic trips,kickbacks etc, come as a package for those who push such systems/techniques.
    let us not mess up with things and make tall claims — there are ethical ways of making buck AND let us not get commercial — everybody is entitled to get rich but try to look inwards before trapping patients AND do a bit of soul searching.

  2. Reyna Barrera, PA Reyna Barrera, PA Saturday, April 21, 2012

    Dr. Neena,
    Congratulations on your perseverance. It takes time, effort, patience and above all dedication to perfect robotic surgery no matter what field of specialty. I commend you for all of these, but most of all for believing that you are doing your patients justice in offering them the best possible procedure whenever possible. There is no better reward than hearing patients tell you how happy they are returning back to routine activities and normal lifestyle so much sooner than they would otherwise. I wish you all the best and continued success. I most sincerely hope you continue dedicated to robotic surgery as your gynea patients will benefit greatly.
    Most fondest regards and best wishes,
    Reyna Barrera, PAC
    Texas

  3. Dr P K Bajaj Dr P K Bajaj Saturday, April 21, 2012

    excellency in technology being done . Dr Neena Kindly accept my congratulations. Hope you will keep it up with still better improvements.
    Best wishes,
    Dr P K Bajaj

  4. Ranjit Singh Ranjit Singh Saturday, April 21, 2012

    Hats off to Da Vinci pioneer in India Dr. Neena Singh in the fields of Gynaecology.
    Her relentless efforts to bring the latest Robotic Technology in the reach of common people for performing the most complex Gynaecological surgeries is so much praise worthy. Surgical conditions are always taken as most dreaded situations in human life, specially when the complexities involved are very critical and the affected organs are very delicate to handle.
    The advent of Robotic surgery in the field of Gynaecology is certainly going to bring the BIG relief from the traumatic experience, the patient and the family members used to undergo in the normal surgical procedures besides the patient having the benefits of minimal blood loss , minimal incisions and maximum precision and obviously having minimal after sugery pains and recovery period.
    Hitherto, the most complex Gynaecologicla conditions involving Hysterectomy, Myomectomy,or Gynae Cancers,removal of Endometriotic Cyst of the Ovary and Dermoid Cyst etc may be performed with seamless ease , precision and most important 100% safe and high degree of successful treatment of the conditions under treatment.
    We all join to thank ICRS, New Delhi who have made the Da Vinci a success in India, ofcourse through the highly commendable efforts of Dr. Neena SIngh KUmar.

  5. Prof. Manoj Sharma Prof. Manoj Sharma Wednesday, April 18, 2012

    Ithink one has to go with caution with regards to Indian Gynec cancers.There is no long terms concrete data available on these surgical procedures.
    I have heard and then seen the out come of one robotic enthusiast from Pune.
    However when the PO specimen was studied he had every chance of recurrence and the only choice was to do chemo radiation in that case.
    He too did not have much to offer in terms of data although tall claims were made on my criticism but the realism happened to be something else.
    EVen during the live demonstration of one of the cases tere was total mess . This was quite in contrast to what I saw in the CD of ESGO and IGCS demonstrations at Milano and Praha.

    There is big money involved and Indian commoner may not afford it.

    So far medical and radiation oncology had the maximum corporate pressure to sell but this happens to be the fresh example of corporate pressure..

    There are other priorities with regards to gynec cancers in our country and they need to be attended first.

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