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A new form of laparoscopic hysterectomy – using a robot for assistance – has improved cancer surgery so drastically that doctors say some women with cervical, endometrial or ovarian cancer may not need chemotherapy or radiation following surgery.
“The robot is incredible,” said gynecologic oncologist Ricardo Estape, M.D., who is performing robot-assisted hysterectomies and other gynecologic procedures at South Miami Hospital.
“It not only provides much better visualization of the area, but the view is three-dimensional. And the dexterity we have to maneuver around tight corners and under blood vessels is fantastic.”
It’s the combination of being able to see clearly inside the abdomen and navigate with precision that results in a more thorough removal of cancerous cells, Dr. Estape said.
Stuart resident Roseann Wolcott, 49, benefited from the new technology when she had surgery for ovarian cancer.
“The doctors here were going to do a standard procedure, which involved a large incision and at least a two-month recovery,” she said. “I was thrilled to find that Dr. Estape could do the procedure with the laparoscope and that I’d be able to return to my pilates and ballet classes a week later. The robot was a bonus.”
Ms. Wolcott went home the day after surgery and took several walks. “I did take some pain medication the first and second nights, but I have felt wonderful.” At press time, Ms. Wolcott was awaiting lab results that would determine whether she would need follow-up chemotherapy, but preliminary reports looked favorable.
Baptist Hospital was the first hospital in South Florida to perform robotic surgery, initially using a robotic arm, then in 2001, using the da Vinci Surgical System.
At the time, the robot was used primarily for heart surgery, but additional procedures are now being performed with it, including lung and prostate cancer surgeries and other gynecological procedures such as fibroid removal.
During a robot-assisted procedure, the robot’s “arms” hold surgical tools, including a tiny camera, that slip inside the abdomen through small incisions.
The doctor operates the robot with a joystick at a console, watching every move on a monitor, almost like playing a video game.
“One of the biggest improvements the da Vinci offers over regular laparoscopic surgery is that the robot has wrist-like movements, side to side, and up and down,” Dr. Estape said. He believes it may be easier for some doctors to learn to operate the robotic equipment than standard laparoscopic tools. That’s because the robotic arms move in the same direction as the controls, unlike laparoscopic tools that move in the opposite direction of the controller. So, with the robot, if you direct a piece of equipment to the right, it moves right.
He added that traditional laparoscopic surgery requires him to have a technically superior assistant across the operating table. “Imagine eating fried rice with a friend,” he said. “You hold one chopstick. Your friend holds the other. Now try to get the rice to your mouth. Very difficult. That’s what laparoscopic surgery is without the robot. But I can control all four arms of the robot myself.”
Robot-assisted laparoscopic surgery has the same benefits of standard laparoscopic surgery. Both are considered minimally invasive procedures. Small incisions mean a short hospital stay (usually overnight) and a quicker recovery than standard surgery. There is considerably less blood loss – an average of 900 ccs with traditional surgery, 100 ccs with the new technology. Not every woman is a candidate for robot-assisted laparoscopy. The robot, just like laparoscopy, cannot be used on very large women and some who have had previous abdominal surgeries.
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