Robotic Surgery

              ​In this post, I wanted to discuss robotic surgery and how it has changed how I practice.  There is a lot of debate about the utility of robotic surgery including increased cost, and I would like to share my thoughts on this topic.
               When I trained at the University of Louisville, we did not have a robot.  We completed most of our hysterectomies either open or with normal laparoscopy.  When I began practice in Delaware, the hospital there was interested in starting a robotic program and asked me to help lead its development.  Over several months, administration and myself, travelled on several site visits to look at and speak with robotic surgeons.  From a surgeon perspective, I was intrigued at the new technology, and how it could expand my surgical expertise.  I helped to start and develop that robotic program and chaired the robotic committee for almost 10 years. 
               Open hysterectomy, involving a large incision either at the “bikini line” or sometimes up and down, is a bread-and-butter procedure for gynecologists.  The problem with open hysterectomy is the recovery for the patient.  Open hysterectomy is very invasive, and patients tend to spend one to two days in the hospital.  Their pain is more, blood loss is more, recovery is longer, and complications such as the need for transfusions or infections are higher. 
               Laparoscopic surgery helps to decrease hospital stay, complications, and gets patients back to their lives quicker.  When robotics came into the picture, it allowed for more precision and better visualization.  It allowed me to convert many cases that I would normally do open to robotic, hence helping decrease hospital stay, complications, and improve recovery time. 
               As I started completing robotic cases, I began to see how it just made everything easier.  I control the camera instead of having an assistant do so.  The robotic arms don’t shake so the camera and arms are infinitely steadier that a human holding them manually.   The robot gives me 3D 10x magnification, which makes identifying and dissecting important structures so much easier.  After completing around 100 cases, I then took a “master’s class” and learned from some of the best robotic surgeons in the country.  Now at over 500 cases, I firmly believe robotic is an amazing tool that helps patients. 
               There has been a lot of debate about the “need” for robotic in normal gynecology. This has focused on cost, and certainly everything being equal, robotic is more expensive.  However, everything is not equal.  With experience, my robotic hysterectomies are now faster than my normal laparoscopic hysterectomies and I can use less instruments.  Also, the conversion rate (The number of laparoscopic hysterectomies that must be changed into open hysterectomies) is very low with robotics.  This is a huge factor in both cost and complications.  Every case that must be converted costs a lot and recovery and complications are worse for patients. 
               Robotic has allowed me to expand my surgical expertise safely.  Larger uteruses, endometriosis, and large ovarian cysts can now all be done laparoscopically with improved recovery and less complications.  The important thing to remember with robotics is that the robot does not make your surgeon better.  It is simply a tool that allows a surgeon to do more minimally invasive procedures.  It does not make a bad or average surgeon better.  Just like wearing a pair of Air Jordan sneakers as a teenager never helped me to be better at basketball.  😊 
               I have several links on my site about robotic surgery for hysterectomy, fibroid removal, and endometriosis resection.  Please check them out, and if you are interested in talking about surgical options, please make and appointment.  Thank you. 

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Links For Robotic Surgery