About a year ago, I was in private practice by myself, covering both my practice and that of my partner, Dr. Wollenman, who was ill and recently passed away this July. I was visited by a representative from Intuitive Surgical who asked if I had any interest in learning about robotic surgery. My first reaction was no, because I didn’t see the benefit. Dr. Wollenman and I had been operating together for years, performing most of our hysterectomies vaginally and what could be less invasive than that? Also, to use the robot required a learning curve and time commitment.
As I listened to the rep speak about the technology, and the statistics that over 60% of hysterectomies in this county are performed abdominally (only 10% of mine were abdominal). I thought perhaps the technology would be helpful for ‘other’ doctors who couldn’t operate vaginally. But then the rep discussed other procedures such as myomectomy, endometriosis surgery and vaginal prolapse surgery being done robotically and I started to feel intrigued.
Myomectomy is the removal of uterine tumors called fibroids. It is usually done through an open incision because the uterus is very difficult to suture using traditional laparoscopic techniques. As I watched a video of a laparoscopic myomectomy using the daVinci robot, I was impressed. The surgeon was using the instruments just as if he had shrunk his hands to fit inside of the patient. Cutting, cauterizing and suturing with grace and precision. And the picture was incredible. I was used to performing a myomectomy through an open incision, balancing the size of the incision versus the size of the fibroids and the size of the patient, trying to make it ‘just big enough’, struggling with the lights in the OR to position them so when I moved my head I wasn’t blocking my own view. Here on the video, the picture was beautiful, in 10 times magnified high definition. The rep pointed out to me that in real life it was even better, because the surgeon had a 3D, 10x, high definition picture. My interest grew.
I went home that night, got on YouTube and spent the evening watching videos of various robotic surgical procedures, including surgery for endometriosis and vaginal prolapse, two areas of particular interest to me.
Endometriosis is a benign condition, but can cause significant pain. Often, during surgery for this we find that the endometriosis has implanted over the patients ureters, bladder and rectum. These are particularly sensitive and difficult areas to excise the endometriosis using traditional laparoscopic techniques. But I was seeing the surgeon using the daVinci with precision and dexterity unavailable with traditional laparoscopic instruments (or ‘straight sticks’ as they are nicknamed).
For years, I have been interested in the treatment of vaginal prolapse and urinary incontinence in women. I’ve been to many meetings and conferences to learn the latest surgical techniques. Almost all of what I’ve learned is variations on how to approach the problems vaginally. However, the operation that is considered the ‘gold standard’ to treat vaginal prolapse is called an abdominal sacrocolpopexy. The traditional approach involves making an abdominal incision and fixing a piece of mesh to the tissue in front of the sacrum and the to the vaginal tissues to support it. However, I had gotten away from this, as had many Obgyns, because of the prolonged hospitalization and recovery due to the abdominal incision. Watching videos of laparoscopic sacrocolpopexys with the daVinci robot was very exciting. Patients with complete vaginal prolapse were able to get very good results without the need for large abdominal incisions.
So after seeing the videos and researching the subject some more, I began to think that the daVinci might be a better mousetrap. I made arrangements and traveled to York Hospital in York, PA; which is considered a robotic surgery ‘epicenter’ and observed cases. I was even more amazed and impressed, watching the surgery in person, at the visualization and dexterity afforded the surgeon by the daVinci. I came back to Texas excited and energized to begin training. I made the arrangements and had my training completed in January of 2011. In February of this year, Dr. Sakovich performed the first robotic hysterectomy at Baylor Irving and I performed the second. Needless to say, it was a very exciting time at the hospital as we got the robotic surgery program going amidst our annual DFW ice storm.
Since then, I’ve performed numerous surgeries including hysterectomy, endometriosis surgery, sacrocolpopexy and myomectomy using the daVinci robot. Again each time, I am thrilled and amazed with the visualization I have and the dexterity of the instruments. But one of the things I’ve been most impressed with is how quickly patients are able to recover from surgery. Most of my patients, including those having hysterectomy, are able to go home from surgery the same day and are ready to resume most activities within about 2 weeks. This is an improvement even over my patients who’ve had vaginal hysterectomies.
I would have to say that I’ve become a convert to the advantages of robotic surgery. I’ve also seen some glimpses of the future where we will be able to reduce the number and size of the laparoscopic incisions down to 1 or 2. I truly believe that the robotic surgery technology has allowed me to provide better care for my patients. I feel blessed to have had the opportunity to use the technology and to have joined the group of doctors here at MacArthur OB/GYN who have supported and encouraged my efforts.