Robotic Surgery Gains Traction In Gynecology
A growing number of ob-gyns are adding minimally invasive robotic surgery to their skill set to perform hysterectomies, myomectomies, vaginal prolapse repair, cancer removal, and other gynecologic procedures, according to two experts at The American College of Obstetricians and Gynecologists (ACOG) 57th Annual Clinical Meeting. Patients are increasingly seeking out less-invasive treatment alternatives, including robotic options. Robotic surgery, when used appropriately, benefits both physicians and patients because it reduces blood loss, is less invasive, and shortens hospital stays and recovery times compared with traditional surgery.
Five years ago, "robotic surgery" was not a term commonly used by physicians or patients when discussing gynecologic treatment options. Today, it is quite common and physicians are seeking out robotics to learn if it's an option for their practice, according to Arnold P. Advincula, MD, from the University of Michigan, and Javier F. Magrina, MD, from the Mayo Clinic in Arizona, who presented "Robotic Surgery in Gynecology: Use and Abuse." The session addressed the pros and cons of this cutting-edge technology for ob-gyns and their patients.
In 2000, the US Food and Drug Administration approved the use of a robotic system for laparoscopy, and specifically for hysterectomy in 2005. Robotic surgery allows a surgeon to sit at a console while three or four robotic arms move over the patient according to the surgeon's commands. In gynecology, robotics can be used for hysterectomy, myomectomy, endometriosis, and the removal of endometrial and cervical malignancies.
Benefits of Robotic Surgery
Conventional laparoscopic surgery has a steep learning curve for physicians because it has two-dimensional imaging and involves mastering counter-intuitive hand movements. Robotic surgery, however, solves some of these challenges because it uses three-dimensional imaging and instruments that move just like the surgeon's wrist. The robotic system eliminates normal hand tremors and allows the surgeon to sit, instead of stand, during the procedure, which helps guard against fatigue.
Dr. Magrina said that for endometrial and cervical cancer surgery, studies show that the operating time for robotic surgery is similar to that of laparotomy and equal to or shorter than the operating time for laparoscopy (both of which are less invasive than conventional surgical procedures). When compared with laparotomy, studies have shown that robotic surgery reduces blood loss and shortens patient hospital stays and recovery times. Early data on survival and recurrence is not different from conventional surgery, but long-term data are unavailable.
"What we really need to know is if this holds up long term," Dr. Advincula said. "In cancer surgery, studies show that you can obtain a better surgical dissection, particularly for lymph nodes, but we don't know the five-year survival rates. For myomectomies, we need to know what the long-term impact is on fertility."
Drawbacks to the Robotic System
The biggest downside to a robotic system is cost. The system costs hospitals about $1.6 million and requires an annual $100,000 maintenance contract, according to Dr. Advincula. In addition, surgeons must undergo company-sponsored training. Dr. Magrina said surgeons need a proctor for their first several surgeries, and he recommends that physicians perform animal surgeries before operating on patients.
Another drawback to the robotic system is the lack of consensus about physician training. The FDA requires one- to two-day training to certify that a surgeon can use the system, but certification doesn't mean he or she is ready to operate on patients, Dr. Advincula said. There is no standardized process for privileging or credentialing on the system. Dr. Magrina recommends that each hospital create a privileging or credentialing system to determine the requirements prior to performing robotic surgeries.
Arnold P. Advincula, MD, is associate professor and director of the Minimally Invasive Surgery Program and Fellowship at the
The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization, ACOG: strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's health care.