Robotic surgery

The Da Vinci robot was first used in the USA in 1999. The term ‘robot’ may be misleading: it is a surgical instrument that enables surgeons to perform complex procedures with improved accuracy, fewer complications and faster recovery for the patient than with conventional laparoscopic (keyhole) surgery. The robot does not perform the operation; it enhances the ability of the surgeon to carry out the procedure.

The robot itself comprises four arms, which are attached to small tubes inserted into the abdominal cavity in a similar manner to laparoscopic surgery. The arms control the camera, which provides a binocular view of the abdominal cavity, similar to 3D technology. The arms also control the instruments which are used to carry out the procedure. The robot arms - and therefore the instruments - are controlled by the surgeon who sits at a console, a short distance away from the patient.

The console is attached to the robot by a series of cables which transmit the image of the abdominal cavity to a screen within the console, and which allow the surgeon to manipulate the instruments inside the abdomen. The controls at the console allow the instruments to fully articulate, which means that the full range of movements of the human wrist are transmitted to the instrument. This is in contrast to conventional laparoscopic instruments, which only allow movements in one plane (up and down or side to side) as opposed to the rotational movement possible using the robot.

These features of robotic surgery result in greater precision in ‘keyhole’ surgery. The patient has a procedure which is less painful, is associated with less blood loss and which leads to a more rapid recovery. For the surgeon, it enables more complex procedures to be performed with safety and in many cases negates the need for a large open incision. 

 

Indications for Robotic Surgery in Gynaecology

Robotic surgery is indicated in situations where the enhanced view of the operative field and the greater manoeuvrability of the instruments lead to safer and more precise surgery. It is feasible to perform robotic surgery in many cases where open surgery has hitherto been the most common approach. Examples include hysterectomy for complex situations such as endometriosis, and in the presence of pelvic adhesions (scarring) due to previous surgery or infection. It is also indicated in major pelvic surgery for gynaecological cancer