First ever two incision robotic hysterectomy

I have posted a link to a new video showing the first ever two incision robotic hysterectomy. Two Incision Robotic Hysterectomy.  This hysterectomy is done through only two small incisions, one in the belly button for the camera and one just above the pubic bone for the instruments.  Both would be completely un-noticeable with swim wear.  With the help of my OR staff, we managed to work out the logistics of the robotic arms to allow this.

Single incision techniques have been developed that allow the surgery to be done all through the belly button, but the incision is much larger, between 2.5-3 cm in size.  These incisions are 1-1.2 cm and theoretically would have a lower risk of herniation.

There are limitations with this.  It likely is only possible with hysterectomy and possibly removal of ovaries. Any endometriosis would be difficult to treat this way with excisional approach.

With this technique it is possible to also perform laparoscopic supracervical hysterectomy and total laparoscopic hysterectomy with removal of tubes and ovaries.

I am so excited about this procedure that we can now offer with or without robotic assistance.

Benefits of Robotic and Minimally Invasive Surgery

Robotic Surgery

There has been much talk in Utah recently about the new DaVinci Robot for performing laparoscopic or minimally invasive surgery. It offers many advantages including a minimally invasive approach to surgery, less blood loss, fewer infections, better surgical visualization, and increased dexterity of performing complex laparoscopic procedures, not to mention a more ergonomic and comfortable operating experience for the surgeon.

There are a few hospitals in Salt Lake City which have these laparoscopic robots. They are allowing physicians in the Salt Lake area the ability to offer their patients advanced laparoscopic procedures instead of surgery performed through larger, traditional incisions.

I have trialed one of these robots at a conference, and it is truly a neat device. It allows a simplicity in performing advanced dissection techniques, and laparoscopic suturing. Access to a laparoscopic robot would provide many more surgeons the opportunity to learn advanced procedures without the time and effort of a fellowship or extended training.

Although there is an increase in cost to performing robot assisted surgery, the overall cost is still lower than a traditional "open" surgery.

To surgeons who are already trained and skilled in advanced laparoscopic surgery, the robot does not at this time offer too many advantages except in difficult cases. Gynecologic surgeries performed by laparoscopy include surgery for: hysterectomy, extensive endometriosis, uterine fibroids, adhesion, pelvic prolapse and bladder drop surgery.

Robot assisted laparoscopy is an upcoming addition to women's surgery. There are thousands of "robotic" surgeries performed each year. For years, traditional laparoscopic surgeons have been struggling to find a route to decreasing the number of open surgeries performed. Robotic surgery will dramatically increase the number of physicians able to perform minimally invasive surgery. Hopefully we will finally see a change in the type of surgery done for the majority of women that will allow them to get back home, go back to work, and get back to life quicker with less pain.