1. Robotics In Benign Gynecologic
Surgery – FUTURE ?
Dr Sapna Raina
Senior Consultant
Dept of Obstetrics and Gynaecology
Narayana Health City
2. ● The quest for improved patient outcome has been a driving force
for adoption of novel surgical innovations across surgical
specialties.
● The field of minimally invasive surgery is undergoing rapid
advances.
● The advantages of minimal invasive access surgery over open
surgery are clear.
●
Less pain
●
Smaller incisions
●
Faster recovery
●
Shorter hospital stays
●
Reduced infection rates
3. Limitations Of Conventional Laproscopic Surgery
# The indirect way of observing and manipulating -
●
●
Complicates the surgeon's depth perception
Disorders the surgeon's eye-hand coordination.
# The use of long instruments operating at a greater
distance from the tissue magnifies hand tremor and
further reduces operative precision.
# The limited degree of freedom of the instrument tips
restricts the surgical angles in accessing the pathology
and tissue planes.
# The inferior ergonomic position adopted by the
surgeon during surgery increases fatigue and discomfort,
compromising performance and dexterity.
Steep Learning Curve!!!!!!!
4. The main limitation of laparoscopic surgery is that it is skill based.
#Even after training, only a few skilled surgeons can perform
complicated surgeries .
The arrival of surgical robotics has begun a new era in minimally
invasive surgery !!
5. ●
● Ability to control three surgical instruments in addition to a camera
● Another important advantage is the intuitive hand movements when
using the robot,
In straight stick laparoscopy, the hand and instrument movements
are counterintuitive.
● Tremor filtration and allows for precise movements.
6. EndoWrist Instruments (above)
Masters (below)
Robotic instruments have 7
degrees of freedom as the human
hand
●
●
Allow the surgeon to easily reach behind structures and negotiate difficult surgical angles.
Perform difficult tasks like intra corporeal suturing and knot-tying.
7. ● Operating in the sitting position and facing directly forward toward the
3-D operative image- IMPROVED ERGONOMICS
● Together with self-control of the camera and an ergonomic console -
Reduce fatigue
Contribute to the shorter learning curve for robotic surgery
Robotic surgery allows the surgeon, with no
previous laparoscopic training, to provide
the patients with the advantages of MIS.
8.
9. Firefly – Seeing is Believing !!
A surgeon’s most important surgical tools are not just her surgical
instruments and hands, but also her eyes.
The system is able to change between views of standard endoscopic
images in real time and images of the tissues illuminated with the dye.
10. Firefly fluorescence technology provides imaging guides and real-time
identification of anatomical reference points.
Vascularized tissue,
vessels,
ureters,
lymph nodes
intravenous injection of indocyanine green (ICG), which is activated
with near-infrared light.
11. A stable camera with 3D high definition vision with advanced firefly
technology offers precision and microsurgical dissection.
15. Robotic
Hysterectomy
Laparoscopic
(Total &
Laparoscopic
assisted vaginal)
Total abdominal
Hysterectomy
Vaginal
Hysterectomy
Total no. of cases 261 76 299 51
% of cases with severe
adhesions secondary to
prior pelvic
surgeris/Endometriosis/
PID
55% 15% 45% 0
Total OT time(min) 234 195 160 171
Anasthesia time 220 188 145 157
Docking time 25 12 - -
Skin to skin incision
time
194 164 120 128
Avg blood loss 50 ml 150ml 250ml 500 ml
Intra-op complication - Bladder rent-2 - -
16. Robotic
Hysterectomy
Laparoscopic
(Total & Laparoscopic
assisted vaginal)
Total abdominal
Hysterectomy
Vaginal
Hysterectomy
Conversion to open 0 3 Not applicable 0
ICU stay(PACU) 9 hrs 10hrs 10hrs 12 hrs
Total hospital stay
Post op complication - - Internal bleeding-re-
opening-1
-
Pain score
00 hrs 6 8 10 8
06 hrs 6 8 10 6
12 hrs 4 6 10 4
18 hrs 4 6 10 4
24hrs 2 6 10 4
Day 1 2 4 8 4
Day 2 2 4 8 4
Total hospital stay 2.52 2.61 3.5 3.0
Re-admission 0 0 2 0
Resumption to day –
to-day activities
5 7 15 11
Re-admission 0 0 2 0
17. When you hear Robotics,
Imagine What We Can
Accomplish Together!!!!
18. Disadvantages Of Robotic Surgery
● Absence of haptic or tactile feedback.
This is partially compensated by the three dimensional spatial view
and visual clues.
● The capital cost associated with robotic surgery is the single most
prohibitive factor in its uptake.
●
19. And ,it Is Just The Beginning!!
● The decision whether robotic surgery should become mainstream in
gynecological surgery or remain another surgical technique in the
gynecological surgeon’s toolbox, requires quite a few more randomized
controlled clinical trials.
● In 1983, a mobile phone cost 4000 dollars. The battery charge lasted
only 20 min, and their size, shape and weight were similar to that of a
brick !!!!!
● Today, robotic surgery is in its infancy, like the mobile phone industry
was in the 1980s, We all know the rest of the cell phone story.
