The Future of Women's Surgery: Understanding Robotic-Assisted Gynaecological Procedures

What is robotic surgery?

Contrary to what some might think, it is not performed by a robot on its own; rather, the surgeon operates from a console, using the robotic arms to guide miniaturized surgical instruments through tiny incisions. These arms have greater flexibility than human hands and can make incredibly precise movements.

A robotic surgical system features 3 main components:

The Surgeon Console: The surgeon sits at an ergonomically designed computer station inside the operating room, viewing the surgical site in a magnified, high-definition 3D image and manipulating the instruments through the masters and foot pedals.

The Robotic Arms: The patient-side cart holds interactive robotic arms with surgical tools and a camera.

The Translation System: The computer instantly translates the surgeon's hand, wrist, and finger movements at the console into highly precise, real-time movements of the robotic instruments within the patient's body.

Role of Robotics in Gynaecological Surgery

Robotics has revolutionized gynaecology by transforming complex open surgeries into highly precise, minimally invasive procedures. The US FDA approved the system for gynaecological conditions in 2005 based on preliminary evidence of safety and efficacy from their early experience with myomectomy and hysterectomy at the University of Michigan. The advent of robotic-assisted surgery has transformed the field, offering improved visualization, tremor reduction, superior ergonomics, and enhanced precision.

What are the Gynaec Surgeries can be done by robotics?

Hysterectomy: Removal of the uterus for conditions like heavy bleeding, fibroid uterus, adenomyosis endometriosis or cancer, offering a lower rate of conversion to open surgery.

Myomectomy: Removal of uterine fibroids while meticulously reconstructing the uterine wall to preserve future fertility.

Endometriosis Resection: Precise excision of deep infiltrating endometrial tissue from delicate structures like the bladder, bowel, and pelvic nerves.

Gynaecologic Oncology: Staging and radical surgeries for endometrial, cervical, and ovarian cancers, including complex lymph node.

Sacrocolpopexy, Pectopexy: Surgical correction of pelvic organ prolapse using mesh placement with highly accurate suturing.

What are the patient benefits?

Less Pain & Blood Loss: Smaller incisions mean less intraoperative bleeding and significantly lower post-operative pain.

Shorter Hospital Stays: Many patients are discharged within 24 hours.

Faster Recovery: Patients generally return to normal daily routines within 2 to 3 weeks.

Reduced Complications: Lower risk of surgical site infections and post-operative adhesions.

Advantages over Laparoscopic surgery:

The advantages of this robotic technique are smaller incisions, leading to lower morbidity, less postoperative pain and shorter hospital stays which are similar to any minimally invasive surgery. However, robotics do seem to have an edge in highly complicated procedures when extensive dissection and proper anatomy reestablishment is required.

The Endo Wrist technology allows surgical manoeuvres that are similar to open surgical techniques, thus making it easy for surgeons with less advanced laparoscopic skills to learn and perform difficult tasks like intracorporeal suturing and knot-tying.

The use of robotic assistance in laparoscopy is slowly becoming popular because this technology has enabled surgeons to overcome difficulties of conventional laparoscopy while allowing patients to benefit from minimally invasive surgery.

Surgery for endometriosis is perhaps the most technically challenging surgeries by laparoscopy. The dense adhesions, the loss of function of adnexal structures and the poor reproductive outcome puts enormous pressure of the surgeon to restore anatomy and function completely while all endometriotic implants are removed. However, after a laparoscopic surgery for endometriosis often a gap is felt of what the surgeon wanted to achieve during the surgery and what he is able to achieve. It is possible to bridge this gap by using robotic assistance that enables the surgeon with a detailed and magnified (3-D) surgical view. Endometriosis is perhaps the most suited surgery by robotic assistance.

The reason for the popularity and acceptance of robotic myomectomy is due to the fact that myomectomy is a suture-intensive surgery and assistance with robotic arms makes suturing simple and easy. Robotic myomectomy guarantees a procedure that is as effective as a classic open myomectomy.

Robot-assisted surgery has become a cornerstone of modern gynaecology, offering improved depth perception, reduction in tremor resulting in unparalleled precision, superior dexterity, intuitive movements, autonomy of camera control, improved ergonomics, and hence has expanded capabilities for minimally invasive management of complex gynaecological conditions like advanced endometriosis and gynaecological malignancies. As technology advances, addressing cost and accessibility will be key to maximising its global impact.

Featuring insights from Dr. Sunita Samal,  Obstetrician and Gynaecologist, Apollo Women's Hospitals, Chennai

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