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The benefits of robotics

Robotic-assisted surgery saves lives, improves outcomes


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Joycelynn Phillips has had gynecological problems since she was a teenager. At age 17, she underwent an open abdominal surgery to remove large cysts from her ovaries.

“The recovery time was huge,” the now 40-year-old woman said. “I missed so much school.”

Phillips, who lives in Midland, North Carolina, said cancer runs in her family and, as she aged, she continued to have gynecological problems. She also learned she was BRCA-positive, which meant she carried a gene mutation that significantly raised her risk of ovarian cancer. In January, after suffering through debilitating periods, Phillips had a minimally invasive robotic-assisted surgery to remove her Fallopian tubes and her right ovary.

She healed quickly following the procedure, which was performed by Dr. Matt McDonald, a gynecologic oncologist at Novant Health Gynecologic Oncology Associates in Charlotte, North Carolina.

“I actually went back to work after 10 days and felt great,” Phillips said.

Learn more about use of the da Vinci Surgical System for radical hysterectomy.

However, follow-up visits found that Phillips had endometriosis and three cysts on her remaining ovary. After discussing her options with her doctor, Phillips decided to have a full hysterectomy. “I wanted to cut my risk of cancer, even if it meant early menopause,” she said.

Four weeks after her robotic-assisted surgery, Phillips said she is feeling good. She’s still not cleared to lift heavy objects, but she said she was off her pain medication within four days and she’ll soon be back to work as a hairstylist.

“She’s doing great,” McDonald said of Phillips’ recovery. As a gynecologic oncologist, McDonald said the majority of the robotic-assisted surgeries that he performs are cancer-related. The most common is hysterectomy and lymph node dissection for uterine cancer.

In Phillips’ case, “she didn’t have cancer and so required general gynecological surgery,” he said.

Why robotic-assisted minimally invasive surgery is beneficial

Since its approval by the U.S. Food and Drug Administration in 2000, the da Vinci Surgical System has revolutionized robotic-assisted minimally invasive surgery across the United States. The technique is used to treat a wide range of conditions including urologic, gynecological, thoracic, cardiac, bariatric and head and neck surgeries.

Novant Health uses the system for a variety of minimally invasive surgeries. In the greater Charlotte area last year, the hospital system performed more than 1,200 robotic-assisted procedures, many of them for women’s reproductive health problems. In Winston-Salem, Novant Health performed more than 700 robotic-assisted procedures in 2014 with treatments for gynecologic oncology leading the types of surgeries.

Dr. Pam Oliver, an OB-GYN at Novant Health WomanCare in Winston-Salem said her most common procedure with the da Vinci robot is a total laparoscopic hysterectomy. “I also use it for the treatment of ovarian cysts, removal of ovaries or fibroids and treatment of endometriosis,” she said.

Robotic-assisted surgery allows doctors to perform many types of complex procedures with greater precision and control than traditional open surgery.

“The da Vinci really has transformed gynecologic surgery and patient recovery,” Oliver said. Performing a hysterectomy without the technology could have required an incision from the pubic hairline to the navel instead of a few small incisions, and the hospital stay and recovery time for the patient were much longer, she said.

“Now with this technology, we have less blood loss, minimal pain after surgery and patients can return to work more quickly,” Oliver said.

In the case of hysterectomy with lymph node dissection surgery, McDonald said the advantage of the robotic surgery over an open surgery is not in the cure rate, but in the recovery time and comfort of the patient. “With an open surgery, a patient can expect to be hospitalized three to four days, treated with a morphine pump,” McDonald said. “Once released, the patient would be on pain medication and housebound for two weeks and unable to return to work for six weeks.”

Da Vinci surgeries are much easier on the patient. “They’re in the hospital for approximately 18 hours,” he said. “There is no need for a morphine pump and patients are off narcotics in only a few days. Many can return to work in just a few weeks.”

Minimally invasive robot-assisted surgery’s other benefits include reduced complications, smaller scars, and less pain and blood loss following a procedure. For surgeons, using a da Vinci Surgical System allows them to perform complicated and delicate procedures that may not have been previously possible in hard-to-reach parts of the body.

McDonald said the technology has allowed surgeons to perform surgeries they would not have performed 15 years ago with the rigid laparoscopic equipment available at the time. “Uterine cancer requires a lymph node dissection which is a technically difficult operation,” he said. “With the da Vinci robot, surgeons see better and can manipulate tissue more easily.”

Oliver agrees. She said the three-dimensional camera on the da Vinci allows for better visualization in the treatment of endometriosis, for instance. “I can evaluate endometriosis more clearly and it helps me as a surgeon do a more thorough job,” she said.

How the da Vinci Surgical System works

A surgeon operating the da Vinci system does not stand above a patient. Rather, the physician is seated at a console in the operating room, looking at a monitor and maneuvering foot pedals and joy stick controls. Relying on three-dimensional, high-definition images transmitted by the cameras implanted at the surgical site, the surgeon precisely guides the da Vinci’s robotic arms, which hold instruments placed at the surgery site through tiny incisions.

A surgeon can manipulate the robotic arms to fully rotate surgical instruments remotely. With the remote three-dimensional images taken by the camera, the surgeon has an accurate field of vision that can be greatly magnified.

The newest generation of robot has near-infrared technology to help surgeons accurately distinguish between cancerous and healthy tissue.

Not every patient will benefit from da Vinci surgery, Oliver said, but for those that are good candidates “it has changed the way we do surgery and we have had remarkable results.”





Published: 9/8/2015