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.

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.