Robotic-assisted surgery spreads to gynecology: hysterectomy, myomectomy, tubal ligation.(Gynecology)

LAS VEGAS -- A robotic surgical system may be capable of helping surgeons remove complex gynecologic pathology in a minimally invasive fashion, speakers said at an international congress of the Society of Laparoendoscopic Surgeons.

Three presenters reported their early experience with tubal ligation, hysterectomy, or myomectomy performed laparoscopically with the help of a robotic surgical system originally designed for cardiac and general surgery

Approved for laparoscopic surgery in 2000, the da Vinci Surgical System, marketed by Intuitive Surgical, has been used primarily for mitral valve repair, pelvic lymph node dissection, cholecystectomy, adrenalectomy, Nissen fundoplication, and other nongynecologic procedures. There have been a few reports in the literature about use of the system for tubal reanastomosis or, more recently, hysterectomy. An estimated 134 of the da Vinci systems are in use in the United States, according to a spokesperson for the company.

In 2002, the FDA approved a second robotic surgical system for general and laparoscopic surgery, the Zeus Surgical System by Computer Motion.

Robotic systems have the potential to overcome several limitations of standard laparoscopic technique, such as two-dimensional imaging, hand tremors, and limited dexterity within the body. Drawbacks include a million-dollar price tag, lack of tactile feedback for the surgeon, and machinery set-up time.

During the surgery, one surgeon uses a remote master console to manipulate robotic arms, which maneuver instruments and a laparoscopic camera that provides three-dimensional images. A second surgeon stands at the patient's side, with other operating room personnel nearby.

Dr. James A. Daucher and his associates at East Carolina University, Greenville, N.C., used the system to perform four bilateral tubal ligations, as a way to make the transition from standard gynecologic laparoscopy to robotic laparoscopy. After an intensive, 2-day training program plus additional inanimate and animate laboratory sessions, they chose the Parkland method of tubal ligation as their first robotically assisted surgery, because it is a common, low-risk procedure involving a variety of laparoscopic maneuvers.