Page 15 - Journal of WALS

WJOLS

Making Robotic Surgery Easier and Safer: A Clinical Review

In each and every case I have used the same docking
technique, port placement and instrument selection and have
always been more than pleased with the ease of the
procedure, my patient’s progress and their recovery. In cases
of large uteri and complex pathology, the only change I
make is to move my ports superiorly.
Last, now that endometriosis resection over ablation is
being recognized as the standard of care, learning robotics
has become even more necessary. With the Jain technique,
excising endometriosis from hard to reach areas, like pelvic
side walls, ureters, uterine vessels, bowel, etc. would become
easier.
Fig. 10: Unassembled Rumi with three Koh’s rings and As I mentioned earlier, 4-year-ago, my clear and simple
a vaginal occluder intent was to learn robotic surgery, do a few cases, prove to
myself that it had no benefits over laparoscopy and then
walk away from it guilt-free. To my surprise, for the last
2 years I have not felt the need to do a laparoscopy. I am
convinced that as a robotic surgeon I can do my cases faster
and better than I could do with any other modality.
My laparotomy rate has dropped markedly to almost
less that 2% since I have incorporated robotic in my practice.
Out of the three cases I had to open in last 1 year, except for
one case with multiple fibroids, which I was unable to
complete robotically the other two were found to be bowel
tumors, a GIST and a sarcoma of the small bowel, and a
colorectal consul to be requested intraoperatively.
I am very honored to have been able to present my
technique. I hope it reduces the learning curve and increases
Fig. 11: Assembled Rumi retractor
the incorporation of robotics in a physician’s practices.
CONCLUSION I believe robotic surgery is a win-win for both the patient
and the surgeon compared to traditional laparoscopy, which
In closing, I would like to mention that I have done is definitely a win for the patient but may be a lose for the
approximately 430+ cases using the Jain technique. surgeon, especially in difficult surgeries.
A significant percentage of the cases have been very
complex surgeries with large uteri, 350 lb patients, large ABOUT THE AUTHOR
fibroids for myomectomy, very dense adhesions from
multiple prior surgeries or chronic PID (pelvic inflammatory Meenakshi Jain
disease), yet despite this myriad of compounding conditions, Private Practice, Obstetrician and Gynecologist, Department of
all the cases were quick, smooth and without complications. Obstetrics and Gynecology, St. Petersburg, Florida, USA

World Journal of Laparoscopic Surgery, May-August 2012;5(2):67-71 71