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The next stage in the development of robotic techniques for gynecology was the progression from simple robotic hysterectomy to more difficult combined cases, but this advance required new technology. six weeks after an open operation.ĪDVANCES IN SURGERY: COMBINED BOWEL AND GYNECOLOGIC TECHNIQUES Return to work is recommended in two weeks after a robotic procedure, vs. Our standard length of stay for robotic hysterectomy is same-day/overnight, and for an open case two days post op. The benefits of the increasing percentage of minimally invasive hysterectomies include shorter hospital stays, fewer lost work days, decreased surgical site infections, and increased safety. (Table 1)īy 2013, 14 gynecologists were certified to perform robotic-assisted surgery, with the result that the ratio of open to minimally invasive procedures decreased dramatically. Therefore, the learning curve for traditional straight stick laparoscopic surgery is actually steeper than for the robotic-assisted approach.Īfter the DaVinci robot was obtained in 2008, one robotic-assisted hysterectomy was performed that year, but adaptation to robotic-assisted surgery was rapidly achieved by surgeons in the divisions of gynecology and gynecologic oncology. Other problems associated with traditional straight stick laparoscopy include reliance on the experience level of an assistant use of a two dimensional camera which reduces depth perception and most importantly, the design of unwristed instruments that limits their mobility and dexterity. The mean BMI of Lancaster General Health patients with endometrial cancer is 48.2. Of interest, Pennsylvania has the highest per capita rate of endometrial cancer in the United States. 3 This issue is particularly problematic for patients with endometrial cancer because morbid obesity is their primary risk factor for developing the disease. In a Gynecologic Oncology Group Study, one half of endometrial cancer patients with a BMI of 35 or greater undergoing lymph node sampling required an open procedure to complete the operation, resulting in increased morbidity. As the patient's body mass index increases, surgery becomes more difficult. Traditional straight stick laparoscopic hysterectomy is associated with several problems that limit its utility. Because of the technical difficulty of traditional laparoscopic (straight stick) hysterectomy, only one gynecologic surgeon was performing that procedure, and only two were performed that same year. In 2008, when Lancaster General Hospital acquired its first DaVinci Robot, most procedures were done with open techniques. TRENDS IN SURGICAL APPROACHES TO GYNECOLOGICAL PROCEDURES 2 Since there have been numerous papers published elsewhere that deal with the cost/safety controversies, this article will focus on the advantages that have resulted from the evolution of robotic gynecologic surgery within the Lancaster General Hospital System. In gynecology, a recent publication demonstrated decreased intraoperative and postoperative complication rates compared with other methods of hysterectomy. Currently, cost issues remain contentious depending on one's accounting perspective, but there are benefits that cannot be ignored, including enhanced patient safety, shorter hospitalizations, and more rapid return to work. 1ĭespite the rapidly growing interest in the use of robotic surgery for various surgical procedures, its use remained controversial, primarily due to concerns about cost and safety. By June 30, 2014, 2,153 units were in use in the United States. This system underwent extensive redesign and was reintroduced as the DaVinci Robotic System, which obtained FDA approval in 2000.
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Although it was not successful, Intuitive Surgical licensed this early robot, known as the SRI Green Telepresence Surgery System.
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At that time, the Department of Defense collaborated with the Stanford Research Institute in an unsuccessful attempt to develop a remote battlefield surgical robot. As one would expect, due to the lack of necessary technology, no functional surgical robots appeared until the late 20th century. The DaVinci robot (Intuitive Surgical) was named after the first robot, thought to have been designed by Leonardo DaVinci in 1495.