DaVinci Si Robotic Assisted Surgery

Good news for women in the intermountain area.  Ogden Regional Medical Center has purchased a new DaVinci Si Surgical System.  This new laparoscopic tool will allow more physicians to offer minimally invasive surgery to the women in the surrounding area.  Ogden Regional will also be one of the few hospitals in Utah that have a robotic system to allow women with non-cancerous conditions to have their surgery done with robotic assistance.

New cost comparison studies have recently come out that look at the surgical and patient costs of the robotic system.  These studies have shown that there is very little difference in hospital and patient cost to benefiting from robotics.  The total cost difference is actually less with robotic or laparoscopic hysterectomy compared to "open" hysterectomy.  This does not even take into account the financial benefit of being able to return to work between 2-4 weeks earlier after laparoscopic hysterectomy.

I am excited about the robotic option coming to women of the area for a few reasons.  First, the articulation of the robotic instruments allows a more precise surgery.  Second, I experience less fatigue and body strain which I believe could translate into safer surgery during a difficult or prolonged case.  Third, and most importantly, more women will be able to benefit from minimally invasive surgery as more providers develop the skills to perform advanced laparoscopy through robotics.

Even though robotics allows a surgeon to complete a surgery through small incisions, I still feel it is important to choose a physician with training in and comfort with dealing with difficult pathology.  Things such as severe endometriosis or adhesions could prompt a surgeon planning on robotic surgery to convert to open laparotomy if the surgery appears too difficult to perform robotically.

CBS Evening News Report about Laparoscopic Hysterectomy

While browsing through the American Association of Gynecologic Laparoscopy (AAGL) website, I ran into an article regarding a report on the CBS Evening News. The link to the report and website is on this page below to the right.

It is interesting that over 600,000 hysterectomies are performed in the U.S. each year. Of these, 75% are performed through a large incision in the abdomen. This significantly increases the hospital stay, post operative pain, and recovery time. Only 15% of hysterectomies are performed laparoscopically.

In other posts on this blog, I have deliniated many of the benefits of laparoscopy over traditional "open" surgery. I strongly believe that there are very few instances that would require an "open" surgery. I have even had patients with a uterus up to the belly button, dense pelvic and abdominal adhesions, and severe invasive endometriosis who have had the benefit of a purely laparoscopic surgery. In three years after fellowship I have only performed traditional surgery on 3 patients, two for medical implications and one at patient request.

The relative scarcity of gynecologists offering laparoscopic hysterectomy is due to many things. I believe that the most prominent of these is the lack of advanced training in laparoscopy and the lack of motivation for gynecologists to learn these skills. As pointed out in the article, transitioning from traditional hysterectomy to laparoscopic hysterectomy will likely be patient driven. The laparoscopic option is often not offered to many patients whose doctor does not perform advanced laparoscopic surgery.

Patients must take an active role in inquiring about the benefits of a laparoscopic approach to surgery. As this happens, physicians will see a want and a need to learn these skills and offer them to patients.