Robot helps doctors do surgery

It was as if a dark cloud has descended upon Eliza (not her real name) when she learned she has myoma, a noncancerous growth that develops in the wall of the uterus.

However, the 48-year-old businesswoman was worried about not its symptoms or complications but rather about the possibility that she may have to go under the knife sooner or later.

She was mortified about undergoing surgery as well as the fact that the procedure might leave a scar on her stretch mark-free belly.

For 18 years, such anxiety kept her away from the operating room, that is, until she was finally convinced by Dr. Rebecca Singson, chair of St. Luke’s Global City Department of Obstetrics and Gynecology and head of the medical center’s Robotic Gynecologic program.

Revolutionary

Singson’s option is to use a revolutionary technology that is changing the way surgery is performed in the operating room—the da Vinci robotic surgical system.

According to Singson, robotic surgery may offer significant benefits over other types of surgery. “In many cases where the procedure is applicable, there is less pain and discomfort involved as well as a faster recovery, a lower chance for complications, reduced risk for infection, less blood loss, shorter hospital stays and diminished scarring.”

After the operation, Eliza was finally relieved that her 16-cm myoma was finally removed from her uterus. She was even more elated since there was only minimal scarring and she suffered almost no postoperative pain.

She was back to work in seven days.

“Until the advent of robotic surgery, the best way to deal with multiple myomas was through the abdomen via a 8- to 12-cm incision. If it was lax enough to be accessed vaginally, that was done too. Aside from the removal of myomas, the open technique was also used in most gynecologic surgeries including the reconnection of a previously ligated fallopian tube as well as surgeries that correct a prolapsed vaginal vault,” the doctor said.

Robotic surgery could also be used in the removal of the uterus for benign or malignant condition, lymph node dissection and removal of ovaries or ovarian cysts.

Singson explained that although the technology is called “robotic” it still takes a skilled surgeon with knowledge and experience to maneuver the machine.

“We always clarify to our patients that it is still always the surgeon—not a robot—that performs every aspect of surgery. In fact, the system does not make any surgical maneuvers without my direct control like using tiny scissors to dissect around sensitive structures,” Singson said.

Unlike traditional laparoscopic and open surgeries where the surgeon is beside the patient, the one performing robotic surgery is using a remote console.

Improvement

“Robotic surgery is a great leap over laparoscopic surgery because it employs a three-dimensional vision system instead of 2D, wristed instruments and ergonomic positioning for the surgeon doing the surgery,” she explained.

Robotic surgery uses a high-definition 3D camera to provide the surgeon looking at the console the advantage of depth perception. The images could also  be magnified 10 to 12 times bigger which is far better than what the human eye can see.

While traditional laparoscopic surgery employs straight and rigid instruments, a surgeon using robotic surgery could perform dexterous movements required for difficult dissections.

In robotic surgery, the instruments are “wristed” wherein, the tips of the instruments are capable of rotating as much as the wrist and even go beyond to allow dexterity (7 degrees of rotation) beyond what a human hand can do.

The finger controls on the console also allows the surgeon to perform more natural movements which make suturing and knot tying more easier.

Finer, more precise

“The movements are finer and more precise, especially for performing delicate dissections. Best of all, it does not transmit the tremors of the surgeon so an experienced surgeon can continue to perform surgery even in his advanced years,” Singson said.

Robotic surgery minimizes fatigue because the surgeon sits comfortably at the surgical console and manipulates the hand controls using the fingers and foot pedals in an ergonomic position.

“In fact, since each surgeon has preferences on how to position their eyes, arms and legs on the console, the surgical robot could save these settings. Fatigue is minimized and could even make the surgery a lot more successful,” she said.

Singson said that the era of robotic surgery has come of age and is rapidly revolutionizing the way surgery is performed. “The standard of care is swiftly changing, old paradigms have to be altered to give way to removing diseased tissues and organs in the least invasive way to the human body.”