Robots Now Being Used for Gynecological Cancer Surgery
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 surgical and oncologic outcomes are typically the same as when done with open surgery or in traditional laparoscopic surgery, the robotic technique appears to allow for greater precision, less pain and less blood loss, says Dr. Christopher McCann, a surgeon in the Division of Gynecological Oncology at BIDMC's Cancer Center.
"In most studies it appears to be at least as good as laparoscopic surgery and may have some advantages," says Dr. McCann, who adds that he prefers use of the robot to the other methods for the appropriate surgical candidates.
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.
"It's the same operation, but with the robot there appears to be increased precision and better visualization" Dr. McCann 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. There is an increased range of motion when compared to laparoscopic instruments. It also allows the surgeon to be more independent with less assistance needed from a surgical assistant."
McCann 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 pubic 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.
"Many 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 hours."
In some cases, the robot allows for minimally invasive surgery on patients who ordinarily may not be very good laparoscopic candidates, such as those who are extremely heavy.
"I feel that the robotic technique is most beneficial to the heavy patients, who are at highest risk of developing endometrial cancer, because it allows us to do a minimally invasive procedure on patients who would have otherwise ended up with a laparotomy." he says. "This leads to shorter hospital stays and less wound infections."
"The bottom line," he says "is that the robot is another tool and it can offer a clinical benefit."
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted September 2011