Page 11 - Journal of WALS

WJOLS

10.5005/jp-journals-10007-1152
ORIGINAL RESEARCH Making Robotic Surgery Easier and Safer: A Clinical Review
Making Robotic Surgery Easier and Safer: A Clinical Review

Meenakshi Jain

ABSTRACT simple intent was to learn it, do some cases and then walk
away from it guilt-free. Then I would have the first-hand
The author proposes an alternative method of robotic docking
for gynecologic total robotic hysterectomy surgery. In this side- knowledge, perspective and practical experience I needed
docking method, the robot is docked on the side of the patient. to easily convince myself, my peers and my patients that
The remainder of the patient and trocar setup is similar to my initial gut feelings about robotic surgery were correct,
traditional docking. The author has had an excellent experience
with this method as there does not seem to be an increased that it was indeed a gimmick and provided neither perceived
risk of robotic arm collision as long as the surgeon respects the nor actual benefit over traditional laparoscopic surgery.
basic principle of maintaining at least an 8 to 10 cm distance I had reservations about using this new technology to
between each of the instrument ports.
treat patients who I was convinced I could treat
Keywords: Robotic hysterectomy, DaVinci hysterectomy, laparoscopically. To overcome my reservations, I only used
Robotic surgery.
this technique on very complex cases. The first 10 robotic
How to cite this article: Jain M. Making Robotic Surgery Easier cases I performed were only on patients who were very
and Safer: A Clinical Review. World J Lap Surg 2012;5(2): obese, very complex and had very large uteri, factors which
67-71.
I knew would lead me to not even attempt laparoscopy to
Source of support: Nil begin with.
Conflict of interest: None declared Surprisingly, I was able to do seven of those ten complex
cases robotically. I was thrilled and realized I had saved
INTRODUCTION seven of my patients from all the potential consequences of
a long hospitalization and the longer recovery times typically
I did not want to learn robotics. I was quite content doing
most of my hysterectomies and other gynecological associated with an open surgery. So I continued to do
procedures laparoscopically. robotics but only in very select cases.
I was considered a skilled surgeon by my peers, and
I felt good about myself. I felt as though I was part of an CONCERNS ABOUT ROBOTICS
elite and talented group of surgeons, who were able to do But I still was not completely convinced of the benefits of
advanced laparoscopic surgeries and could give their patient robotics to use as a replacement to laparoscopy. I had the
multiple minimally invasive alternatives to traditional following concerns, which stopped me from incorporating
surgery like LASH, TLH, LAVH, laparoscopic robotics completely in my practice.
myomectomies, etc. The percentage of my patients requiring 1. Lack of control. I was away from my patient and I felt
an abdominal hysterectomy was about 10% or less, all the that in the case of an emergency I would not be able
more telling when compared with the 70% average in the to convert to a laparotomy rapidly and easily.
rest of the USA. 2. There were too many people in the operating room,
When my hospital administrator Mr Conroy approached there were extra staff, Da Vinci reps, an extra
me with the possibility of purchasing a DaVinci robot for anesthesiologist. All this caused too much commotion
the hospital and asked for my support, I clearly informed and confusion.
him of my total lack of interest in this new technology. I 3. The size, presence and operation of the robot appeared
went on and further reiterated my firm belief that this very intimidating and cumbersome.
methodology had no benefits over laparoscopy and was 4. Docking between the legs was especially difficult, it
merely a gimmick. took a long time and appeared very problematic.
Despite my feelings and reservations, I could not deny 5. My assistant was not able to manipulate the uterus
the rapid incorporation of this new technique in the USA the way I wanted, which made the case very frustrating
and the growing claims of potential benefits in using this and as I was away from my patient, even I could not
technology, especially in benign gynecology and manipulate the uterus myself.
gynecological oncology. 6. I was not used to routinely doing port placement above
To clear my conscience, I decided to go through the the umbilicus in the right and left upper quadrants, so
motions of learning robotics. Four years ago, my clear and I felt somewhat out of my comfort zone.
World Journal of Laparoscopic Surgery, May-August 2012;5(2):67-71 67