Da Vinci Si Hysterectomy

Well, today we completed the first surgery in the western United States using the latest Intuitive surgical robot, the Da Vinci Si. Ogden Regional Medical Center in Ogden, Utah purchased this machine a couple weeks ago. After much training and time spent working on the system, the first surgery went without a hitch.

Actual operative time with the robot assistance was similar to my average times with traditional laparoscopy, about 1 1/2 hours for the first case. The actual visualization during surgery was better than what I had experienced with the practice "toys" we used. The 3-D vision was really exceptional. The robotic instruments were very easy to use and the surgeon console is fantastic. The two aspects I like the best are the individual hand clutching of the instruments and the ability to use bipolar energy or monopolar energy with either the cut or coagulation mode. The cutting current is great for minimizing thermal damage to the vaginal cuff when removing the cervix.

The hospital is "all a buzz" and people seem to be excited to offer this advanced surgical tool at their hospital. It is too bad that it took an instrument such as this for people to get excited about minimally invasive gynecology when I and other surgeons have been offering laparoscopic hysterectomy for years. Outcomes should be the same.

With the robot technology, more women will be able to take advantage of the "outpatient" hysterectomy and avoid having their abdomen cut open as more surgeons learn the robotic approach.

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.