The da Vinci Surgical System, first approved by the FDA in 2000, was developed to enhance the precision and visualization of minimally invasive surgery for surgeons who perform delicate and complex operations. Gynecologic surgeons were among the first specialists to embrace the robotic technology because they saw the potential of the da Vinci System to be a powerful tool for improving outcomes in the types of surgeries they perform. The robotic hysterectomy is now one of the most common surgeries performed using the da Vinci system, but the benefits of the technology also make it well suited for use in cases where preserving female anatomy is a priority, such as in the surgical treatment of infertility.
Dr. Magdalene Karon M.D. of Lexington embraced the da Vinci system soon after it was released and has performed over 500 cases with the robot to date. She feels that the da Vinci technology is particularly well suited for use in the surgical treatment of infertility and she routinely uses the system to perform a variety of fertility operations including myomectomy for fibroid removal, resection of endometriosis, reanastomosis of prior tubal ligation, treatment of hydrosalpinx, ovarian cyst decompression and ovarian resection.
Although traditional minimally invasive surgery with laparoscopic technology has allowed for wonderful advances in the surgical treatment of infertility, especially in terms of improved recovery time and less blood loss, Dr. Karon cites important advances of the da Vinci technology that improve outcomes even further.
One of the greatest advantages she describes is the three dimensional, high-definition and magnified images created by the da Vinci cameras. While traditional laparoscopes create two dimensional images, surgeons using the da Vinci system can visualize tissues and instruments almost as if they were working in an open case and can magnify the images up to ten times. This feature is helpful in allowing for precise laser ablation of adhesions, such as those caused by endometriosis or pelvic inflammatory disease, especially when adhesions cause the anatomy to be distorted. Dr. Karon prefers to use the Revolix® laser with the da Vinci system and feels that this laser is superior to CO2 lasers in that it offers more efficient tissue vaporization thus causing less damage to healthy tissue.
Dr. Karon also prefers the Endowrist® instrumentation technology which provides additional flexibility and dexterity over traditional laparoscopic instruments. The robotic instruments are modeled after the human wrist but are designed to achieve greater range of motion than that available to surgeons manipulating hand-held laparoscopic instruments.
The enhanced precision of the robotic instruments make Dr. Karon feel as though she is “operating with the tips of [her] fingers,” and allows her to be gentler on tissues, preserving more normal tissue when making incisions and using surgical lasers—a key in successful fertility surgeries. The enhanced dexterity of the robotic instruments, combined with greater visualization also allows her to make smaller incisions and to use much finer sutures which makes for less post-operative pain and speedier recovery.
Other benefits of the robotic approach include the ability to salvage ovaries in cases, such as dermoid tumor removal, where the ovary has historically been removed. In cases of poly-cystic ovarian syndrome, cysts can be decompressed, often restoring regular ovulation to these patients. Dr. Karon states that the majority of her patients who undergo surgical treatment for infertility are able to conceive within six months following surgery. She is in the process of setting up interactive sessions at St. Joseph’s East hospital in Lexington, where patients can come and see the da Vinci system for themselves. A video of Dr. Karon performing a myomectomy with the da Vinci system is available for viewing at: http://www.youtube.com/watch?v=5EpPEaa55GU
By Jenny Wheeler, MD.
Dr. Wheeler graduated from Mercer University School of Medicine in 2012 and completed an intern year in the University of Kentucky’s Triple Boards Program. She is currently pursing Family Medicine training for 2014.