 |
Minimally Invasive Surgery / RoboticsMINIMALLY INVASIVE SURGERY Traditionally, surgery has involved incisions large enough to reach in and manually perform the procedures necessary to accomplish the tasks at hand. The incisions were then closed with sutures. Experience tells us that longer incisions hurt more. This knowledge led doctors to devise less invasive techniques which in turn led to many procedures that previously involved long surgeries and prolonged uncomfortable recoveries now being done with the laparoscope using incisions you could fit your pinkie through. Obviously this resulted in substantially less pain, shorter hospitalizations, and faster recoveries. Premier examples of this are gallbladder removal and tubal ligation. But there are many others. The field of gynecology, which initially “led the charge” in laparoscopy, mainly with tubal ligation and management of ovarian cysts, pelvic pain, tubal pregnancies, etc., eventually found itself left behind a bit. While laparoscopically assisted vaginal hysterectomy (LAVH), whereby the upper part of securing the blood supply is done through the laparoscope followed by working through the vagina to remove the uterus, became an accepted alternative to the standard abdominal hysterectomy, doing the entire procedure through the laparoscope turned out to be cumbersome, time consuming, and associated with certain complications, mainly injury to the urinary tract, and has never really caught on. Enter the ROBOT-a truly remarkable device that represents the current state of art approach. Developed over the last 12 years or so, the DaVinci machine is a remarkable device and certainly has its place in medicine. Unfortunately there are some drawbacks: namely, the device costs 1.6 million dollars to purchase, requires maintenance, involves discarding the 3-4 instruments used (about $1000 or so) every eight procedures, takes 3-6 hours of O.R. time, and requires 4-5 abdominal incisions. More likely “mildly invasive”, rather than “minimally invasive.” Make no doubt about it: the ROBOT is the approach of choice in specific circumstances, especially GYN cancer surgery and prostatectomy where it has shortened hospital stays, shortened recovery, and improved post op urinary function. But in 80 to 90% of routine hysterectomies, the procedure can be done through the vagina with no abdominal incisions. The average vaginal hysterectomy surgery takes about 25 to 30 minutes, can be done under spinal anesthesia (with sedation), involves same day or overnight stay, and most hysterectomies that cannot be done vaginally can be done faster and at less cost with LAVH using standard laparoscopic equipment. While the time is probably not far off that the open abdominal hysterectomy is a rarity, even then, in skilled hands the vast majority of hysterectomies, even those with large fibroids, can be done vaginally faster with less expense and with no abdominal incisions and essentially the same recovery. Your medical care provider can help guide you.
This information is provided for general information and educational purposes only. It is not intended to be a substitute for a health care provider consultation. For additional information or evaluation -- please consult your health care provider. |
