By Robert A. DeSantis, MD, FACOG
a da Vinci surgeon and Board Certified OB/GYN at Trinity Medical Center
Hysterectomy remains one of the most common surgeries performed in the United States today, second only to cesarean sections. This procedure is performed for numerous conditions including endometriosis, uterine prolapsed, fibroids and cancer.
While the majority of hysterectomies are still being performed by making a large incision in the abdomen - resulting in a large scar, increased pain, and extended time away from work while recovering - there is another option.
New advancements with the da Vinci® surgical system provides patients and physicians with a minimally invasive approach that shortens hospital stays (less than 24 hours in most cases), recovery time, and time away from work. Other potential benefits over traditional surgery include less pain, less blood loss, lower risk of wound infection, less scarring and fewer complications.
Compared to traditional laparoscopy, the da Vinci Robotic Surgical System provides us with enhanced capabilities and offers high definition 3D views with 12 times the magnification. Any procedure that I would have normally performed through a traditional large incision on the belly can now be done with the da Vinci® using a one to two centimeter incision.
Don’t let the term “robot” scare you. The system cannot act on its own; the surgeon is always in control of every move. The robotic technology allows the surgeon to sit at a console viewing the procedure through a 3D image. The surgeon’s fingers grasp the master controls below the display and the system translates the surgeon’s hand, wrist and finger movements into precise, real-time movements inside the patient.
Regarding gynecologic conditions, hysterectomy is the most common procedure I perform using the da Vinci® system. And I, along with other experienced surgeons, have taken the procedure beyond the basics. I have also used the da Vinci® for endometriosis surgery, pelvic organ prolapse, ovarian cystectomy (cyst removal), tubal reversal in women who have undergone sterilization and desire reversal, myomectomy (removal of fibroid tumors from the uterus with preservation of the womb), and trachelectomy (removal of the cervix in women who have previously undergone a supracervical hysterectomy).
I trained on the da Vinci® system in 2007 and have now done over 300 cases. Prior to becoming a da Vinci surgeon, I was performing approximately 50 percent of my hysterectomy cases open. Over the past 36 months, my open rate is <1% for hysterectomy and <5% for all gynecologic surgery. A recent study comparing da Vinci®, traditional laparoscopy and open abdominal hysterectomies was released and the operating time in the hands of an experienced da Vinci surgeon was shorter, blood loss was 50 percent less than traditional laparoscopy and 75 percent less than open, and the average hospital stay was 1.1 days compared to 1.6 for traditional laparoscopy and 5 days for open.
Although individual results may vary, I have had patients return to work within one week after hysterectomy, and I even had one patient return after one day. Interestingly, 20 percent of patients who underwent an attempted hysterectomy with traditional 2D laparoscopy required open surgery to complete the case compared to 4 percent of those who underwent da Vinci surgery. The system allows me to treat patients with more advanced benign disease including significantly enlarged uteri (due to fibroid tumors) and pelvic adhesive disease and scarring (due to severe endometriosis and/or prior pelvic surgery).
I, along with my partners J.C. Brock, MD and Andrew Lemons, MD, now provide this state-of-the-art surgery at the Alabama Robotic Institute at Trinity Medical Center. For more information about the da Vinci Surgical System® at Trinity Medical Center please call 592-5499 or visit www.trinitymedicalonline.com.