Robotic surgery or, to be more precise, robot-assisted laparoscopic surgery, is a method of laparoscopic surgery which is performed with the aid of a state-of-the-art robotic system, known as Da Vinci®.
(e.g. robot-assisted laparoscopic removal of uterine fibroids (fibromyomectomy), aka robotic fibromyomectomy and/or Da Vinci® Fibromyomectomy).
What is the Da Vinci® Robotic System?
It is the first and only Robotic Surgery system so far, and is the only one approved by FDA (Food & Drug Administration, USA) since 2000. It performs the entire range of laparoscopic surgeries as well as a large number of conventional procedures.
How did it start?
The Da Vinci® system was created in the mid-'90s at Stanford Research Institute (SRI) by Dr. Ajit Shah and Dr. Phil Green thanks to a grant by the U.S. Defense Advanced Research Projects Agency (DARPA) and NASA. The original intention was to establish a tele-medicine and tele-surgery unit providing assistance to remote conflict zones. Over time, the program was acquired by Integrated Surgical Systems (now Intuitive Surgical) and developed into its current form under the name Da Vinci®. The first procedures were performed in 1998. Following approval by FDA in 2000, its reputation started spreading in the US and then in Europe and the whole world.
Today, more than 850(!) Da Vinci® robotic surgical systems are being used throughout the world; more than 150 are used in Europe and 6 in Greece.
For Cardiac Surgery alone, over 180 systems are being used worldwide, while its use has been increasing for a number of surgical procedures in Urology, General Surgery, Endocrine Surgery and Gynecology over the last decade.
What does it consist of?
Da Vinci® consists of the following components:
An ergonomically designed console, where the seated surgeon views and performs the procedure;
4 robotic arms; a 3D endoscopy system is attached to the central arm and one instrument is attached to each of the other 3 arms;
An endoscopic tower;
A special laparoscopic camera with TWO HD lenses for real 3D imaging (InSite Vision);
Special laparoscopic instruments easily adjusted to the robotic arms, like a "cassette"; the nurse is able to change one or all instruments within a few seconds, depending on surgeon’s needs.
How is a Da Vinci® procedure performed?
Da Vinci® allows the surgeon to perform remote surgical procedures, with the surgeon’s hands outside the patient’s body.
At first, as in laparoscopy, the abdomen is filled with CO2 for better visualization and comfortable surgical manipulation. Then, 3 or 4 minimal incisions are made in the anterior abdominal wall through which the trocars are placed. Next the robot is driven at the front or at the side of the surgical table and snaps the robotic arms to the trocars. At the same time, the laparoscopic instruments specially designed for the robot are also applied. The surgeon sits in a special console in the operating room and places his/her head in a special opening in the upper part of the console allowing him/her to view the 3D image directly from inside the abdomen. On the lower part of the console, the surgeon places the forefinger and the thumb of the right and left hand on the right and left control respectively; each one is able to open, close and rotate freely, just like the wrist of the hand, the one independently of the other. Using these controls, the surgeon is able to move the robotic arms and the surgical instruments inside the patient’s body and perform the procedure.
Benefits of Robotic Surgery:
Greater stability and precision of surgical movements, by eliminating hand trembling seen when using conventional laparoscopic instruments, as well as greater detail thanks to magnification and 3D imaging of the surgical field, has the following benefits:
- Surgical precision in the proximity of sensitive, vital organs, such as vessels, nerves, etc.;
- More secure approach of technically difficult and inaccessible sites;
- Reduced physical strain of the surgeon, especially when performing technically-demanding and time-consuming procedures;
- Reduced blood loss;
- Reduced risk of intra- and post-operative infections;
- Reduced post-operative pain and discomfort;
- Significantly reduced hospitalization stay;
- Faster recovery and return to everyday activities.
Applications of Robotic Surgery in Gynecology:
- Robotic fibromyomectomy;
- Robotic excision of deep infiltrating endometriosis;
- Robotic Total Hysterectomy with or without the ovaries and fallopian tubes;
- Robotic Radical Hysterectomy for cervical cancer;
- Robotic lymph-node dissection for gynecologic cancer staging.
In Greece, the first Robotic Total Hysterectomy and systematic lymph node dissection for endometrial cancer (surgical staging) was performed in July 2009 at HYGEIA hospital by Dr. Hilaris and his team.
Finally, it should be noted that we have been using the DaVinci robotic system since 2002 at Stanford University Hospital, California, long before the technique became known in Europe, let alone Greece. We have fairly gained the experience and reputation of a surgical team that is fully aware of the essential medical indications when using the system in surgical gynecology.
In 2009, Dr. G. Hilaris and his team performed the first ever robot-assisted surgical staging in Greece, for endometrial cancer in a 39-year-old patient.
Laparoscopic surgery has gained popularity over the last decades as an alternative method for performing a multitude of procedures.
Hysteroscopy (from the Greek word “ύστερον”= uterus and endoscopy) is the detailed examination of the uterus (or endometrial cavity).