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Robotic Surgery for GYN Cancers

By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent

Surgeons at Beth Israel Deaconess Medical Center are now using robots to perform surgery for early stage gynecological cancers.

The da Vinci® Surgical System was first used in prostate surgery. Now, it is being used to perform surgery for women's cancers such as those of the uterus, cervix and, occasionally, the ovaries.

While outcomes are typically the same as when done with traditional open surgery or in minimally invasive laparoscopic surgery, the robotic technique appears to allow for greater precision, less pain and less blood loss, says Dr. Babak Litkouhi, a surgeon in the Division of Gynecological Oncology at the BIDMC Cancer Center.

"It appears to be at least as good as laparoscopic surgery and may have some advantages," says Dr. Litkouhi, who adds that he prefers use of the robot to the other methods for the appropriate surgical candidates. "I'm happy to have it at my disposal. It is a very nice tool."

da Vinci® Surgical System

The system involves a surgeon's console, a robotic cart with four arms manipulated by the surgeon -- one to control a camera and three to manipulate instruments -- and a high-definition 3D vision system.

When the robot is used, the surgery is performed in a similar manner as in laparoscopic surgery, where tiny incisions replace larger ones and the surgeon manipulates small instruments from outside the body. In the case of the da Vinci® system, the robot holds the instruments and the surgeon controls the robot.

"Its the same operation, but the advantages of the robot are that there appears to be increased precision," Dr. Litkouhi says. "There is a tendency to mimic open surgery better. The robot has hands that act like wrists. You can open and close instruments, flex the wrists and rotate them up and down. There is an increased range of motion and greater freedom when compared to laparoscopic instruments. It all translates into increased dexterity."

Litkouhi also says there is data showing that with robotic surgery, compared to laparoscopic surgery, it is less likely the surgeon will have to switch over in mid-operation to a traditional open surgery, which requires a large incision from the public bone to the belly button. Sometimes, once the operation is started, conditions may require the surgeon to abandon the minimally invasive method in favor of the open method.

In most cases, gynecologic cancers are treated with a hysterectomy - the removal of the uterus and cervix, as well as removal of the ovaries. Lymph nodes and other areas are also removed and biopsied to check for cancer spread.

"For appropriate surgical candidates, I tend to do most of my uterine and cervical cancers robotically," Dr. Litkouhi says. The robot seems to be better when it comes to keeping the ureter, which runs from the kidneys to the bladder, out of harm's way, he says.

"Many of surgeons feel it is easier to do the operation with the robot," he says. "You are sitting down. There is less fatigue. You are not holding instruments for four hours."

In some cases, the robot allows for minimally invasive surgery on some patients whom ordinarily may not be very good laparoscopic candidates, such as those who are extremely heavy, he says. In many such cases, patients must have traditional open surgery.

"The bottom line is that the robot is another tool and it's a good tool," Dr. Litkouhi says.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted July 2010

Contact Information

Minimally Invasive Gynecologic Surgery
Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
East Campus, Shapiro 8
330 Brookline Avenue
Boston, MA 02215