A common operation in the United States, hysterectomies are now going high-tech as many surgeons embrace robotics as another tool to help them do their jobs better.
NorthShore University Health System has two robotic surgical systems used for hysterectomies and related procedures, one at Evanston Hospital and another at Skokie Hospital. In McHenry County, Centegra Health System recently announced it is offering the robotic procedure for hysterectomies.
Such use of the technology is growing worldwide, from 69,000 procedures in 2009 to 110,000 procedures in 2010 and 146,000 procedures in 2011. Most of the procedures took place in the United States, said Angela Wonson, spokeswoman for Intuitive Surgical, manufacturer of the robotic da Vinci Surgical System.
"We have a waiting list now because we're doing so many of them," said Dr. Carolyn Kirschner, a gynecologic oncologist at NorthShore University Health System who has performed robotic surgeries since 2008.
The robotic alternative is a form of laparoscopic surgery, a minimally invasive procedure in use since the 1980s that uses an inserted video camera and special thin instruments. Robotic surgery differs from traditional laparoscopic process in several ways.
It features a robot-controlled video camera and two or three robotic arms. Instead of standing bedside and working with straight instruments, which can be difficult to maneuver, surgeons sit in front of a three-dimensional screen and manipulate a different type of tool, Kirschner explained.
"The instruments are 'wristed,' which allows you a lot more dexterity and precision," Kirschner said.
Kirschner said she has found the procedure especially useful in her practice, which involves mostly cancer-related surgeries. Magnification capabilities in the camera provide a better vantage for assessing evidence of cancer spread, as well as a clearer view of vital structures to avoid, such as large blood vessels.
While laparoscopic surgery is considered a minimally invasive process characterized by quicker recovery times, less blood loss and less pain, and shorter hospital stays, another technique used for years for hysterectomies is considered the least invasive process.
"Vaginal hysterectomy, I think, is the gold standard for hysterectomies, if it is feasible to do so," said Dr. Angela Chaudhari, full-time faculty member at Northwestern Feinberg School of Medicine and attending gynecologist at Northwestern Memorial Hospital.
If the uterus is small, the vaginal process makes the most sense, Chaudhari said.
In addition to cancer, a number of factors can cause a uterus to enlarge and become a candidate for a laparoscopic procedure, Chaudhari explained.
Laparoscopy is an option for removing fibroids, which are painful but benign tumors. It is also useful for treating adenomyosis in which the endometrial tissue, which lines the uterus, grows into the muscular wall of the uterus, causing heavy and painful periods.
A worst-case scenario may call for traditional surgery.
"Uteruses that are quite large can require a larger abdominal incision," Chaudhari said.
Use of a particular laparoscopic technique, involving traditional straight instruments or robotic instruments, depends on the patient and the surgeon, Chaudhari said.
While she prefers vaginal procedures, Chaudhari uses both traditional and robotic laparoscopy.
"I think the robot is an additional tool that can be useful," said Chaudhari, who has used it since 2009. "I think that the da Vinci robot is good for procedures that require a lot of suturing. That can be a very challenging part."
The Mayo Clinic in Arizona, one of the first institutions to use robotic laparoscopy, pioneered the technique in the early 2000s, said Dr. Rosanne Kho, assistant professor and fellowship program director in the clinic's Division of Urogynecology, Department of Gynecological Surgery.
The robot is particularly useful for obese patients, Kho said.
"The amount of effort is the same, no matter what the size of the patient is," she noted.
Because the equipment is versatile and easy to manipulate, it is well-suited for cancer-related surgery.
"It has also been very helpful in complex procedures that involve a significant amount of dissection," Kho said.
"I would be a very strong advocate for the robot because of its ability to provide many surgeons with another tool so that they won't have to give the patient a large incision," she added.
That's partly what drew Centegra Health System.
"We use minimally invasive techniques to perform hysterectomies on our patients whenever possible," said Dr. Darby Murphy, an obstetrician and gynecologist with Centegra Physician Care. "We talk to each woman about whether she is a candidate for robotic or laparoscopic hysterectomy and we explain the options that are available."Copyright © 2014, The Baltimore Sun