Understand Your Gynecologic Surgery Options

Robotic-assisted surgery offers a new treatment option for women with gynecologic conditions, enabling minimally invasive procedures with higher accuracy.  

By Dr. Chantawat Sheanakul  

For women considering surgery to treat disorders affecting the female reproductive system, robotic-assisted surgery with the da Vinci system has become an increasingly popular treatment option. Da Vinci’s robotic technology enables surgeons to carry out a number of minimally invasive gynecologic procedures with high accuracy and precision, using very small incisions.  

Understanding Gynecologic Conditions

Gynecologic disorders are medical conditions affecting a woman’s reproductive organs and structures in the abdominal and pelvic area, including the uterus, ovaries, fallopian tubes, cervix and vagina. Most women will experience at least one gynecologic disorder during their lifetime.  

These disorders tend to cause one or more of the following symptoms: severe pain in the lower abdomen; abnormally severe menstrual pains; vaginal bleeding; vaginal discharge; a lump protruding from the pelvic floor; weight loss and/or other menstrual cycle irregularities, such as increased or decreased blood flow, or in some cases, a missed menstrual period despite not being pregnant.  

Gynecologic Surgery Techniques

Medications and other non-surgical treatments may prove effective for treating some gynecologic disorders. In some circumstances, surgery could be the best option. Usually there are three types of surgical techniques to consider:

• Open surgery, a conventional type of surgery that requires a relatively large surgical incision and potential cutting of layers of skin, tissues and muscles. Compared to other less-invasive methods, recovery from open surgery takes longer due to the more extensive physical trauma and the larger incision wound.
• Laparoscopic surgery, a form of minimally invasive endoscopic surgery whereby a laparoscope — a thin tube-like tool with a tiny camera and light on its tip — is inserted through a small incision in the abdomen. This technique causes minimal physical trauma without affecting nearby tissues, organs and structures. It minimizes pain and potential surgical complications such as blood loss and infections and takes less time to recover from than with open surgery.
• Robotic-assisted da Vinci surgery, a technique to perform minimally invasive operations with the help of robotic arms. It is designed to improve surgical efficiency, accuracy and safety, particularly for highly complex procedures involving difficult-to-access surgical sites. The typical incision (and resulting scar) for this type of surgery is similar to laparoscopic surgery.

Suitable Conditions for Robotic-assisted Surgery

Da Vinci surgery is increasingly favored for treating the following gynecologic conditions: 

• Uterine fibroids
• Gynecologic cancers such as uterine, cervical and ovarian cancers
• Ovarian cysts and tumors
• Endometriosis
• Perineal membrane disorders
• Infertility
• Pelvic organ prolapse 
• Chronic abdominal pain

Robotic-assisted Surgery: How it Works

Robotic-assisted gynecologic surgery typically involves the following general process:  

1. Pre-surgery preparations: Pre-surgery examination will be carried out, which includes blood pressure and blood glucose levels measurement and the balance of fluids and minerals analysis; other protective measures will also be taken to reduce the risk of infection. Patients are usually required to abstain from eating or drinking for at least eight hours prior to surgery to prevent food particles being ingested into the lungs.  

2. As surgery begins: After anesthesia is administered, the patient is fitted with an endotracheal tube to assist breathing. The surgeon will inflate the abdomen with carbon dioxide, to increase the space of the surgical area and give the surgeon a clear, unobstructed internal view. 

The robotic arm is located beside the patient’s bed, and the surgeon controls the insertion of the laparoscope and other surgical devices through four small surgical incisions in the abdomen. The surgeon sits at the da Vinci control console a few feet from the patient and performs the surgery using the real-time, high clarity 3D internal images transmitted by the camera attached to the robotic arm.  

The da Vinci system sends real-time signals from the surgeon’s hand movements to move the robotic arm with exactly the same movements made by the surgeon. Once the internal surgery is finished, equipment such as the laparoscope is removed, and the surgeon does the suturing of the incision.   3.

3. Post-surgery considerations: For most robotic-assisted gynecologic surgeries, patients typically stay two or three nights in the hospital before returning home. The doctor will determine whether any dietary restrictions are necessary; for example, eating only bland foods for a certain period. And doctors usually have patients return for a follow-up examination about one week after surgery to assess recovery and healing progress.  

The Benefits of Robotic-assisted Surgery

Robotic-assisted surgery offers an array of potential benefits, including:

• High levels of safety, accuracy and precision; the system allows the surgeon to view high-resolution 3D images of the patient’s internal organs and structures.
• Greater surgical flexibility due to the robotic system’s range-of-motion capabilities. The robotic arm can be flexed in seven directions, compared to four directions for laparoscopic surgery. The robotic arm also can reach tight spaces more easily than human hands or devices used in laparoscopic surgery.
• Da Vinci’s anti-vibration system keeps the surgeon’s hands steady, reducing the impact of human error.
• Because it is a type of minimally invasive surgery, surgical incisions are very small. This can translate to less blood loss, less scarring, less pain, and fewer wound infections as well as other post-surgery complications.
• Patients enjoy faster post-surgery recoveries; hence hospital stays could be shorter, and quicker transition to normal activities.

Risks and Complications

Through millions of patient surgeries, robotic-assisted surgery using the da Vinci system has built an excellent safety record since its introduction nearly 20 years ago. All surgeries, whether open, laparoscopic or robotic-assisted, come with some risk of infection, bleeding or anesthesia-related complications. They occur infrequently and are usually not serious in nature.   

Talk to Your Doctor

If you are considering gynecologic surgery, it is important to talk to your doctor to understand the potential benefits, risks, and possible complications for each available surgical treatment option. This will help in making an informed decision based on your individual situation.  

About the Author

Dr. Chantawat Sheanakul is an OB/GYN specializing in gynecologic oncology and minimally invasive surgery at the Women’s Center, Bumrungrad International Hospital.

The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects. BAMBI News welcomes volunteer contributors to our magazine. Please contact editor@bambiweb.org.