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Robotic Surgery in Benign Gynecology

Robotic Surgery in Benign Gynecology. Lewis D. Lipscomb, M.D., FACOG, FACS Winston-Salem Womancare www.w-swomancare.com. Disclosures. Proctor – Intuitive Surgical, Inc. Objectives. Which patients are candidates for robotic surgery? What is the learning curve for robotic surgery?

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Robotic Surgery in Benign Gynecology

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  1. Robotic Surgery in Benign Gynecology Lewis D. Lipscomb, M.D., FACOG, FACS Winston-Salem Womancare www.w-swomancare.com SLCWH Min InvGyn Surgery Conference 5/6/11

  2. Disclosures • Proctor – Intuitive Surgical, Inc. SLCWH Min InvGyn Surgery Conference 5/6/11

  3. Objectives • Which patients are candidates for robotic surgery? • What is the learning curve for robotic surgery? • Should I pursue training to become a robotic surgeon? • How can I perform robotic surgery efficiently? SLCWH Min InvGyn Surgery Conference 5/6/11

  4. TAH SLCWH Min InvGyn Surgery Conference 5/6/11

  5. Patient Selection Straightforward Patient • Healthy • Normal BMI • Parous • No history of abdominal or pelvic surgery • Normal sized pelvic organs • No endometriosis SLCWH Min InvGyn Surgery Conference 5/6/11

  6. Patient Selection Straightforward Patient Challenging Patient • Healthy • Normal BMI • Parous • No history of abdominal or pelvic surgery • Normal sized pelvic organs • No endometriosis • Comorbidities • Obesity • Nulliparous • History of abdominal or pelvic surgery • Large pelvic organs • Endometriosis • Possible malignancy SLCWH Min InvGyn Surgery Conference 5/6/11

  7. Traditional Laparoscopy SLCWH Min InvGyn Surgery Conference 5/6/11

  8. Robotic Instrumentation • Articulating wrist • 7 degrees of freedom • Small/delicate dissectors • Tremor reduction SLCWH Min InvGyn Surgery Conference 5/6/11

  9. SLCWH Min InvGyn Surgery Conference 5/6/11

  10. Transition to Robotics • Ochsner, Baton Rouge, LA • Retrospective chart review of 200 hysterectomies performed between 11/04 and 1/07, 2 private practice surgeons • 100 pre-Robotic hysterectomies vs. 100 post-Robotic hysterectomies • Patients were candidates for TVH, TLH, or TAH Payne TN, Dauterive FR. A Comparison of Total Laparoscopic Hysterectomy to Robotically Assisted Hysterectomy: Surgical Outcomes in a Community Practice. J Minim Invasive Gynecol 2008; 15: 286-291. SLCWH Min InvGyn Surgery Conference 5/6/11

  11. Laparotomy Rate Overall TAH Rate Conversion Rate Payne TN, Dauterive FR. A Comparison of Total Laparoscopic Hysterectomy to Robotically Assisted Hysterectomy: Surgical Outcomes in a Community Practice. J Minim Invasive Gynecol 2008; 15: 286-291. SLCWH Min InvGyn Surgery Conference 5/6/11

  12. Operative Time SLCWH Min InvGyn Surgery Conference 5/6/11

  13. Pre-Robotics vs. Robotics Blood Loss Hospital Stay SLCWH Min InvGyn Surgery Conference 5/6/11

  14. Robotic Surgery in Benign Gynecology • Gyn Surgeries routinely performed via laparotomy include: • Total Abdominal Hysterectomy • Nulliparity • Fibroids • History of cesarean • Known or suspected endometriosis • Known or suspected pelvic adhesions • Obesity • Myomectomy • Sacrocolpopexy • Tubal Reanastomosis SLCWH Min InvGyn Surgery Conference 5/6/11

  15. Laparotomy SLCWH Min InvGyn Surgery Conference 5/6/11

  16. Robotic OR Efficiency • Dedicated robotic team • Introduce new team members one at a time • Anesthesia buy-in • Positioning • Optimize skin to console time • Anticipate case length (room in to room out) • Morcellator? • Adhesions? • Endometriosis? SLCWH Min InvGyn Surgery Conference 5/6/11

  17. Should I pursue training in robotic surgery? • Case volume • At least one potential case per week • Confident with laparoscopy • Routinely perform operative laparoscopy, TLH • Genuine interest in robotics as a specialty SLCWH Min InvGyn Surgery Conference 5/6/11

  18. Conclusion… • Improved surgical visualization, dexterity, and precision should bring more patients into the minimally invasive realm. • Only one surgeon is necessary, increasing productivity. • Many patients contemplating open surgery may be candidates for robotic surgery. • Robotics will play a critical role in reducing laparotomy rates for complex GYN surgeries. • Skilled, dedicated, efficient surgeons will excel in robotic surgery. SLCWH Min InvGyn Surgery Conference 5/6/11

  19. Discussion… SLCWH Min InvGyn Surgery Conference 5/6/11

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