Robotically-assisted surgery is the term used for the technological development that uses robotic systems to aid in surgical procedures. It was developed to overcome the limitations of minimally invasive surgery and enhance the capabilities of surgeons performing open surgery. Surgical tasks are performed by a robotic system which is controlled by the surgeon.
In 2011, Apollo Hospitals, Chennai, launched the Apollo Institute of Robotic Surgery, bringing in the latest state of the art — da Vinci Robotic System — the first of its kind in Tamil Nadu.
The da Vinci Robotic Surgical System provides seven degrees of freedom in the instruments (meaning the number of independent movements the robot can perform). The surgeon provides precise movements of the instruments using console controls. Robotic surgery in gynaecology is one of the fastest growing fields.
da Vinci robotic assisted surgery has a role in many surgeries for benign gynaecological conditions. It provides greater ability to perform minimally invasive surgery on patients with compromised anatomy and tissue planes (endometriosis, prior pelvic surgeries, larger pathology and obese patients). da Vinci myomectomy (removal of fibroids) offers minimal pain and scarring, hence quick recovery and return to normal activities.
Robotic hysterectomy offers precise and efficient dissection (ureters,vesico uterine reflection, colpotomy and quicker and easier vaginal cuff closure.
Sacrocolpopexy typically requires difficult dissections and extensive suturing. da Vinci sacrocolpopexy is considered the gold standard for vaginal vault prolapse.
It provides easier and more precise rectovaginal and presacral dissections. Improved handling of the suture and mesh leads to a more accurate graft placement and attachment.
Robotic assisted surgery has a definite role in gynaecological oncology. In addition to cases of endometrial and cervical cancer, the robotic approach has also been used for ovarian cancer staging and resection of isolated tumour recurrence. It has also been successfully used for fertility sparing in young patients with early stage cervical cancer.
Operating times are fairly equal between laparoscopic and robotic hysterectomy. Cost of surgery is one of the disadvantages.Robotic surgery in gynaecology has already proven itself to be of great value, particularly in areas inaccessible to conventional laparoscopic procedures. It has the potential to expand surgical treatment modalities beyond the limits of human ability.
(The writer is a consultant obstetrician and gynaecologist at Apollo Hospitals, Chennai)
Types of instruments used
Viewing and controlling console
Surgical arm unit (which includes 4 arms).
Advantages of robotic surgery