Robotic Surgery in Gynecology

History of Robotic surgery:
The daVinci Robot® is manufactured by Intuitive surgical®,a company based in Sunnyvale, California. It received the FDA approval in 2000 for the use of the robotic platform in general laparoscopic surgery and has since then been exponentially adopted in medical centers both in the United States and Europe. It is used in multiple disciplines ranging from Urology, to general surgery, gynecological surgery, cardiothoracic and pediatric surgery. An estimated 250 000 robotic procedures were performed worldwide in 2009, triple the number of procedures performed in 2007. Robotic surgery has now changed patient care and established itself as one of the most important and promising breakthroughs in medical innovation.

The 3 components of the robotic system: Surgeon console, patient cart and tower.

What is the daVinci robot?
The daVinci Robot is a system that is attached to the laparoscopic trocars giving the possibility to the surgeon to perform a laparoscopic surgery with multiple advantages. It is comprised of 3 main elements -the surgeon console where the surgeon sits and operates, has a 3 dimensions HD view of his surgical field and where he inserts his fingers in manipulators allowing him to perform precise and complex movements. -the patient bed side cart which contains the 3 or 4 arms that will be attached to the patient, an endoscope (camera) and 2 or 3 micro instruments according to the surgery performed. -A tower that has the main computer and ancillary equipments needed like an energy source, the computer mainframe, cable connections etc…

Robotic surgeon console

Robotic patient cart

3D HD view and manipulators

What are the Advantages of robotic surgery?
The correct term for Robotic surgery is Robotic assisted Laparoscopic surgery, it is an advanced form of laparoscopic surgery. The advantages can be divided into advantages over the traditional “open” surgery: translating into less pain, better cosmesis ( small 8mm incisions instead of one large 8-10 cm incision) less blood loss and risk of blood transfusions and short hospital stays (less than 24 hrs compared to the 3 or 4 days of open surgery) Advantages over laparoscopic surgery include : better ergonomics , more precise movements , endowrist movements and tremor reduction, improved 3D HD endoscopic view ;all allowing the surgeon to perform the most complex surgeries without compromising on the cosmesis and the minimally invasive approach.

Translations of the surgeon’s movements into robotic arms movements

Robotic assistance in Gynecologic surgery:
When a women needs to undergo surgery , in addition to treating the disease ,the final cosmetic result is also very important parameter that has to be taken in consideration. Now with robotic surgery, the most complex gynecological surgeries can still be performed with very small (8 mm) incisions leaving very little to no surgical scars. When medically indicated removal of the uterus (hysterectomy); removal of uterine fibroids (myomectomy); surgeries for endometriosis or the ovaries, certain types of gynecological cancers and surgeries for pelvic organ prolapse can now all be performed using this newest technology. Giving a combination of both an optimal surgical treatment with at the same time optimal cosmetic results.

Endowrist function of the 8 mm robotic instruments

This surgical innovation has changed how surgeons look at the treatment of disease. Patients do not only deserve the best surgical outcomes, they also deserve to have the best cosmetic outcomes at the same time. Clemenceau medical Center is the first and only facility in Lebanon that provides Robotic assisted Laparoscopic surgery. Experts in different specialties that apply Robotic surgeries comprise the Robotic team at CMC and offer surgical care and expertise not found anywhere else in Lebanon or the region. Dr Karim Nawfal is an obstetrician gynecologist with a specialty in minimally invasive and robotic gynecologic surgery. He recently moved back from the United States where he completed his training in this field and is a full time physician at CMC.

Comparison of the incisions of traditional open surgery to robotic surgery