Robotic Surgery: A Less Invasive Procedure

Faculty physicians in the College’s Department of Obstetrics and Gynecology and University Medical Center are the first in Tuscaloosa to use robotic surgery to perform hysterectomies and other gynecological procedures. They say the robotic system allows them to operate with more precision and less fatigue, while patients experience improved outcomes, especially in shorter hospital stays, less pain and quicker recovery times.

Marion Reed, MD, an obstetrics and gynecology physician and assistant professor in the department, uses the robotic system for many of the hysterectomies he performs. He says the minimally invasive nature of robotic surgery and the resulting smaller incisions mean that “some of my patients have only had to do this procedure as an out-patient procedure. Others only need to stay in the hospital overnight.” Reed uses the da Vinci robotic system located at DCH Regional Medical Center in Tuscaloosa.

Robotic surgery was first introduced a decade ago by the U.S. military, which wanted surgeons to be able to operate on wounded soldiers on the battlefield without putting themselves at risk. While the military’s efforts were not successful as hoped, the robotic method was picked up by the Sunnyvale, Calif.-based Intuitive Surgical Inc., maker of the da Vinci System.

The da Vinci System consists of a large device with four arms that hover over a patient-side cart and are controlled from a nearby console. Three of the arms are for tools that hold a scalpel, scissors and other surgical instruments and operate through small incisions in the patient’s body; the fourth arm is for an endoscopic camera with two lenses that give the surgeon stereoscopic vision from the console.

The surgeon sits at the console and looks through a viewfinder. With joystick- like controls in each hand, the surgeon manipulates the arms on the robotic system while looking at images captured by the camera on the viewfinder. The robotic arms’ joint-wrist design exceeds the natural range of motion of the human hand, and the view of the patient and the surgical area is magnified up to 10 times through the camera. “Use of this system has tremendously improved surgeon’s dexterity,” Reed says.

Since its introduction, the U.S. Food and Drug Administration has been expanding approval of the use of robotic surgery. Urologists were among the first to use robotic surgery, followed by cardiologists and gynecologists. Today, robotic surgery is used to perform minimally invasive heart, prostate, gynecological and other common operations.

Reed is quick to point out that the robotic system is not a self-driven device, but rather a tool in the hands of the surgeon. He says surgeons must go through special training to use the machines.

While robotic surgery is a natural progression from laparoscopic surgery for hysterectomies, Reed says he uses robotic surgery as an option and not a total replacement of laparoscopic surgery or vaginal hysterectomies.

Laparoscopic surgery is minimally- invasive surgery performed with the help of a telescope-like device that lets the surgeon see inside the abdomen or pelvis. But with laparoscopy, a surgical assistant must hold a camera, and the surgeon operates while standing, using hand-held instruments that have no wrists. The surgeon must also look up and away to a nearby video monitor to see an image of the surgical procedure being captured by the hand-held camera. Reed says with robotic surgery, there is a better view of the patient surgical area as well as more precision and less fatigue.

He acknowledges there is a “mixed reaction” to robotic surgery among surgeons and physicians because surgical procedures using a robotic system can take longer. But he believes that in many cases, the advantages of robotic surgery outweigh the additional time.

“I wish I could have done all my surgeries this way,” he says.