Advances in Robotic Surgery Are Changing Hysterectomy

GUADALAJARA, Mexico – Robotic surgery has changed the way doctors treat patients who are considered for hysterectomy, said Dr. Carlos Alcivia Smith at the XXXI International Congress of Gynecology and Obstetrics.

According to a gynecologist, endoscopist, and robotic surgeon, this natural evolution has revolutionized the surgical process to make scars smaller and smaller over time. In addition, the development of tools has allowed to talk about “excellence”.

The operating room has also been changed from a laparoscopic to a “robot operating room, large enough to accommodate three carts: the doctor’s cart or the control cart, where actually the surgeon which works with the control; and the robot car, which is the tower where the intelligence is located,” explained Alcivia Smith.

Some of the problems with conventional laparoscopic surgery are bilateral images, hand-eye coordination problems, increased body tremors, learning curve, and limited movements.

“No matter how skilled the surgeon is, it is clear that vibration or fatigue destroys them. There are very interesting estimates that robotic surgery extends the work of the doctor up to 12 years, he said.

In 1998, the first robotic surgery was performed on a human. In 2000, the first gynecologic robotic surgery (tubal anastomosis) was performed, and in 2002, the first robot-assisted hysterectomy was performed.

“Since 2011, we have known that hysterectomy should be a minimally invasive surgical procedure. The open surgery used in hysterectomy should begin to disappear because endoscopic surgery offers great advantages in terms of recovery , bleeding, complications, etc.,” said Alcivia Smith. The laparoscopic approach has become the gold standard, and the open approach is becoming less common.

“Since robotic surgery was first used in these types of procedures, its use has increased, and it is now the standard procedure in the United States for the surgical procedure of benign gynecologic pathology,” he said. Alcivia Smith, certified gynecologic. robotic surgery in the United States.

Alcivia Smith presented data showing the current state of global robotic surgery data. More than 14 million operations have been performed with the Da Vinci system to date. More than 8600 systems have been installed, and more than 76,000 surgeons have been trained on this platform.

“In Mexico, we have treated 15,400 patients with the Da Vinci system or platform since 2012. Twenty-seven hospitals have robotic surgery programs, and we have 31 national proctors . [ie, certified surgeons in robotic surgery who have completed the required number of cases]. The metropolitan areas of Guadalajara, Mexico City and Monterrey have the most programs and cases,” said Alcivia Smith.

A hysterectomy, like any surgery, always begins before anyone enters the operating room. It starts when the patient comes in for a consultation. This procedure requires a “clear Trendelenburg position,” dealing with high intra-abdominal pressures with a 15-mmHg intubation, the use of hot solutions, and the use of a Postoperative Recovery Improvement Protocol, among other things.

Alcivia Smith outlined every step to consider during the process. “First of all, to confirm the port, you must make sure that you have not damaged any of the hypogastric veins. We always start with a salpingectomy, then we cut and open the surrounding ligaments, -utero-ovarian and infundibulopelvic ligaments, opening the broad ligament leaves, arterizing the uterine arteries, developing the vesicouterine area, uterine artery ligature, colpotomy, surgical excision, then colporrhaphy.”

Alcivia Smith concluded by showing that robotic surgery is a strong area of ​​endoscopic surgery with significant growth. “The ergonomics of the tools and their clear and user-friendly interface are important tools for the surgeon. The flexibility of the tools allows to perform difficult or complete surgical tasks.”

Alcivia Smith has disclosed no relevant financial relationships.

This story is translated from Medscape Spanish Edition using several editing tools, including AI, as part of the process. Human editors have reviewed this content before publication.