Robotic Pelvic Surgery

Robotic Pelvic Surgery

What is robotic surgery?
Robotic surgery is a way of doing surgery using small incisions (usually no more than 1/2 inch long) and is sometimes called “minimally invasive surgery.”

How is robotic surgery done?
The current robotic surgical system consists of four components:
1) a console where the surgeon sits, views the screen, and controls the robotic instruments and camera via finger graspers and foot pedals;
2) a robotic cart with three or four interactive arms that hold instruments through trocars attached to the patient
3) a camera and vision system that allow for a three-dimensional image of the pelvis using image synchronizers and illuminators
4) wristed instruments with computer interfaces that translate the mechanical movements of the surgeon’s hands into computer algorithms that direct the instruments’ movements within the patient.

During robotic surgery, the primary surgeon sits unscrubbed at the console, away from the operating room table and at some distance from the patient, using finger graspers to control the instruments. Foot pedals and a clutch are used for camera control, activation of energy sources, focusing, and switching the robotic arm.

Four to five trocars are used, including one through which a 12-mm or 8-mm three-dimensional endoscope is placed. Instruments are passed through three to four ports, three of which can be controlled by the robotic arms. One additional arm, not controlled by the robot, may be placed as an “assistant” port. Assistant surgical team members pass robotic instruments and sutures through these ports for use by the primary surgeon. These ports also provide suction, irrigation, and countertraction. Instruments for suturing, clamping, endosurgery, and tissue manipulation are used with the robotic arms.

What are the benefits of robotic surgery?

  • The console provides three-dimensional imaging with improved depth perception, and the surgeon has autonomous control of the camera and instruments.
  • The robotic arm, with its wristed joint and six degrees of freedom, allows for greater dexterity than unassisted surgery and decreases normal hand tremors.
  • There is less pain after robotic surgery than after open abdominal surgery, which involves larger incisions, longer hospital stays, and longer recovery times.
  • Recovery from robotic surgery generally is faster than recovery from open abdominal surgery. The smaller incisions that are used allow you to heal faster and have smaller scars.
  • The risk of infection also is lower than with open surgery.
What are the risks associated with robotic surgery?
Robotic surgery can take longer to perform than open surgery. The longer time under anesthesia may increase the risk of complications. Some problems that can occur with robotic surgery include the following:
  • Bleeding or a hernia (a bulge caused by poor healing) at the incision sites
  • Internal bleeding
  • Infection
  • Damage to a blood vessel or other organ, such as the stomach, bowel, bladder, or ureters
For what surgical procedures can robotic surgery be used?
  • Hysterectomy can be performed. The uterus is usually removed in one piece through the vagina.
  • Ovarian cystectomies can be performed
  • Some cancer surgeries can also be done
What problems can robotic surgery be used to diagnose and treat?
  • Fibroids—Fibroids are growths that form inside the wall of the uterus or outside the uterus. Most fibroids are benign(not cancer), but a very small number are malignant (cancer). Fibroids can cause pain or heavy bleeding. 
  • Ovarian cyst—Some women have cysts that develop on the ovaries. The cysts often go away without treatment. But if they do not, your ob-gyn may suggest that they be removed.
  • Pelvic floor disorders—Robotic surgery can be used to treat urinary incontinence and pelvic organ prolapse.
  • Cancer—Some types of cancer can be removed using laparoscopy.
What kind of pain relief is used during robotic surgery?
Robotic surgery is usually performed with general anesthesia. This type of anesthesia puts you to sleep.

What happens after the procedure?
After the procedure, the instruments and most of the gas are removed. The small incisions are closed. You will be moved to the recovery room. You will feel sleepy for a few hours. You may have some nausea from the anesthesia. If you had outpatient surgery, you will need to stay in the recovery room until you can stand up without help and empty your bladder. You must have someone drive you home. You usually can go home the same day. More complex procedures, such as a hysterectomy, may require an overnight stay in the hospital.

What should I expect during recovery?
For a few days after the procedure, you may feel tired and have some discomfort. You may be sore around the incisions made in your abdomen and navel. The tube put in your throat to help you breathe during the surgery may give you a sore throat. Try throat lozenges or gargle with warm salt water. You may feel pain in your shoulder or back. This pain is from the small amount of gas used during the procedure that remains in your abdomen. It goes away on its own within a few hours or days. If pain and nausea do not go away after a few days or become worse, you should contact your ob-gyn.

How soon after robotic surgery can I resume my regular activities?
Your ob-gyn will let you know when you can get back to your normal activities.

What signs or symptoms should I watch out for after laparoscopy?
  • Fever
  • Pain that is severe or gets worse
  • Heavy vaginal bleeding
  • Redness, swelling, or discharge from the incision
  • Fainting
  • Inability to empty your bladder

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