Tomorrow's technology at the service of today's women
The science of Surgery is characterized by the concept of evolution, with a constant search for newer, more effective and safer methods, with the maximum benefit for the patient in mind. A typical example of this is the introduction and prevalence of laparoscopic surgery, which is now tending to completely replace traditional 'open' surgery, thus revolutionising the field. This revolution is now being continued by robotic surgery, the most recent technological development in the field, with particular application in Gynaecological Surgery.
Robotic surgery was originally developed in America, in collaboration with NASA, to create a way to perform surgery remotely. This system would allow surgeons to perform operations by manipulating the robotic system on soldiers on the battlefield. From this initial vision, the surgical robot evolved and in the year 2000 was officially introduced into clinical practice as the "Da Vinci" Robotic Surgery System by Intuitive, USA. This system has now evolved into the 4th generation of robotic systems and has been at the service of the patient through our GynSurgery team at "Agios Lukas" Clinic since the year 2019.
What is the procedure? What happens in the operating room?
Robotic surgery differs in some important areas from conventional laparoscopy. Specifically, the surgery begins with fitting the robotic arms into 8 mm holes made in specific locations in the abdomen. One of the arms carries the camera, essential equipment for imaging the surgical field located within the abdomen, while the others carry specialized surgical instruments. The surgeon, using a special control console and through specialised controls, then controls the arms and performs the necessary manipulations to carry out the surgery.
What are the technical advantages of robotic gynecological surgery?
Being the latest in modern medical technology, robotic surgery offers a wealth of technical advantages. The most important advantage is the excellent handling that it allows the surgeon, who is able to perform movements with millimetre precision. At the same time, the system, through its specially designed controls, directly mimics the surgeon's hand movements, unlike conventional laparoscopy, whose instruments have a conventional trigger handle. Overall, the handling system allows the Surgeon a range of motion similar to open surgery, and therefore better control. This system is highly complemented by the 3D visualization of the surgical field through the console, which unlike the 2D display of conventional laparoscopy allows depth estimation, improving the accuracy of movements. The combination of these two systems (manipulation and imaging) offers total control of manipulations, precision of movements, increased dexterity and ultimately an excellent therapeutic outcome.
What are the clinical advantages for the patient?
The technical advantages of the method mentioned above translate directly into clinical advantages for the patient. In particular, robotic surgery allows complex procedures to be performed safely, even in patients with underlying pathological conditions such as obesity, chronic cardiorespiratory diseases, metabolic diseases, hereditary diseases, etc., a category of patients in which such procedures are more risky with conventional methods. In addition, thinner manipulations allow access to more anatomically inaccessible areas, thus ensuring more complete treatment of the disease with more safety. Robotic surgery also minimizes intraoperative injuries, blood loss and surgical complications, leading to a reduction in inflammation and adhesion formation. These translate into minimized hospitalization time, but also recovery time, with some patients returning to their routine even the next day.
In which gynecological conditions is robotic surgery applied?
robotic surgery can be used by trained surgeons for most common gynecological conditions, with the GynSurgery scientific team and the Da Vinci X system offering safe and reliable solutions to a number of common gynecological conditions, such as:
- Infertility
In many cases of infertility there are underlying gynaecological conditions, such as endometriosis, fibroids, adhesions, tubal diseases, etc., which negatively affect both natural conception and assisted reproduction treatments. Robotic technology, with its high surgical precision, ensures the restoration of normal anatomy in a safe and reliable manner, potentially improving fertility.
- Endometriosis
Endometriosis is a common disease, which occurs in 10% of women of childbearing age and up to 50% of women with infertility. Potentially, it causes a plethora of clinical symptoms, the most common feature being pain, and has a significant negative impact on women's health, psychology and quality of life.
Robotic treatment of endometriosis offers excellent results through precise, 3D imaging and precise surgical manipulation that allow the safe and complete exclusion of the disease foci, even from anatomically inaccessible areas. Our team's expertise in endometriosis has attracted the interest of an international team of experts, who commissioned us to edit the Greek edition of the scientific textbook "Endometriosis", CRC Press, London, 2022.
- Uterine fibroids
Fibroids are the most common gynaecological condition, affecting up to 80% of women, causing a multitude of symptoms and often affecting fertility. Robotic Surgery offers a safe and reliable option for patients with fibroids, providing a significant improvement in quality of life, combined with an excellent aesthetic result.
Robotic fibroid surgery is a subject of intense interest from the scientific community, with our team having been invited by a distinguished international medical journal to write a scientific article on the subject. We hope that this effort will contribute to the international recognition of the place of robotics in modern fibroid surgery.
- Prolapse (hernia) of pelvic organs (uterus, bladder and bowel)
Prolapse is a common pathology, particularly in older, polygamous women, often leading to unpleasant symptoms such as weight loss, sexual dysfunction and urological disorders. Robotic surgical repair of prolapse offers excellent results in treating symptoms and improving women's quality of life.
- Gynaecological Oncology
Robotic Surgery, in selected cases of gynecological malignancy, offers excellent oncological outcome and at the same time reduces complications, especially in patients with many comorbidities, reduces blood loss and minimizes the possibility of converting the surgery into open surgery.
In conclusion
Robotic Gynaecological Surgery technology, in the hands of a skilled and experienced medical team, offers safe and reliable solutions to a wide range of conditions.
By Dr. Elias Tsakos MD(Hons), BSCCP, DFFP, FRCOG
Obstetrician Surgeon Gynaecologist
Member of the British College of Gynaecologists
Director of the Assisted Reproduction Unit "EmbryoClinic"
Certified by the European Society for Robotic Surgery (SERGS)
Scientific Manager of Robotic Gynaecological Surgery, Clinic "Agios Lukas", Thessaloniki
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