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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.

  1. Dr Neena Singh
  2. 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.

Dr Neena Singh
Director, Robotic Gynaecology
International Centre for Robotic Surgery, New Delhi

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