Robot-assisted procedures have been used in medical practice for over 30 years. Most often, doctors perform a prostate removal (prostatectomy) with the help of the da Vinci robotic system. The second place in terms of the number of surgeries performed is taken by the removal of the uterus (hysterectomy) and other types of urogynecologic surgical procedures.
Minimally invasive robot-assisted gynecologic surgeries (da Vinci surgeries) have been actively used in clinical practice since 2005. The list of clinical cases when the traditional surgery may be substituted with the robotic intervention is expanding constantly. Today the technique is used in the treatment of ovarian cysts, uterine fibroids, endometrial and cervical cancer, urinary incontinence, and pelvic organ prolapse. With the help of the robotic system, doctors treat endometriosis, correct obstruction of the fallopian tubes during the infertility treatment, relieve pain in the small pelvis and other symptoms.
- Malignant neoplasms of the female reproductive system
- Treatment of uterine fibroids
- Urinary incontinence and pelvic organ prolapse
- Endometriosis treatment
- Advantages of robotic surgery
- Treatment of gynecologic diseases in Germany with Booking Health
Malignant neoplasms of the female reproductive system
More often, the da Vinci robotic system is used in gynecologic oncology for the minimally invasive treatment of endometrial cancer. Less typical indication is the therapy of cervical cancer. The da Vinci robotic system is used to perform such procedures via the tiny incisions:
- Radical hysterectomy, i.e. removal of the uterus
- Radical trachelectomy, i.e. removal of the cervix uteri and part of the vagina
- Pelvic and para-aortic lymphadenectomy, i.e. removal of lymph nodes that may be affected with cancer
Due to precise movements of the robotic arms, the da Vinci system allows carrying out surgical treatment of uterine cancer with minimal health risks. Removal of the uterus (hysterectomy) along with the uterine appendages and lymph nodes is performed through the minimal incisions.
The fluorescence imaging used during the procedure gives the surgeon the opportunity to detect all foci of the oncological process. First, the doctor performs an intravenous injection of the contrast agent. Due to the effect of luminescence, tumor tissues in which the contrast medium accumulates glow green. With the help of fluorescence diagnostics, a surgeon can clearly define the border between healthy and pathologic tissues, which increases the efficiency of surgical procedures.
The main advantages of removing a malignant tumor of the uterus using the da Vinci robotic systems in comparison with the traditional surgery are as follows:
- Blood loss is reduced by more than 4 times compared to the traditional surgery due to making only 1-2 cm incisions
- Need for blood transfusion is reduced by more than 10 times compared to the traditional surgery
- Need to hospital stay and pain syndrome are reduced by more than 3 times compared to the traditional surgery
- The risk of intraoperative complications is 5 times lower compared to the traditional surgery
- The risk of long-term postoperative complications is 3 times lower compared to the traditional surgery
During robot-assisted hysterectomy, the sentinel lymph node technique can be used. The contrast medium is injected close to the tumor site. It eventually accumulates in the nearest lymph nodes. The procedure allows understanding where metastases are most likely to be present. Therefore, it reduces the risk of cancer recurrence significantly.
During the treatment of cervical cancer, ovarian transposition with the help of the da Vinci robotic system is performed before the radiation therapy starts. Through the tiny incisions, movement of the ovaries inside the abdominal cavity allows avoiding radiation exposure. The surgery allows preserving the reproductive potential. After trachelectomy, a woman can conceive and give birth to a child. Nevertheless, even in women with the completely removed uterus, eggs continue to mature in the ovaries. Such eggs can be successfully used in IVF and surrogacy medical programs.
Treatment of uterine fibroids
With the help of the da Vinci robotic system, myomectomy can be performed via the 1-2 cm incisions. Myomectomy includes removal of the myomatous node while preserving the uterus. This procedure combines the advantages of laparoscopic and open surgeries. On the one hand, it is minimally invasive; on the other hand, it allows forming a reliable scar on the uterus. As a result, a woman preserves reproductive potential, she can become pregnant and give birth to a child without a cesarean section.
The da Vinci robot-assisted surgeries are primarily recommended for women:
- With large myomatous nodes that deform the uterus
- With multiple nodes in the uterus
- Those who are planning a natural pregnancy or IVF after myomectomy
After the da Vinci robot-assisted procedures, a natural pregnancy occurs more often than after the laparotomy. This is connected with the minimal incisions and less trauma to the abdominal cavity tissues. With this type of surgeries, visceral adhesions that lead to the fallopian tubes obstruction are formed less often.
Urinary incontinence and pelvic organ prolapse
With the help of the da Vinci robotic system, the surgical correction of urinary incontinence can be performed. It is mainly recommended for women with urinary incontinence against the background of the pelvic organ prolapse.
Pelvic organ prolapse develops in 15-30% of women over 50. In every third patient, it leads to complications and symptoms that have a negative impact on the quality of life. Up to 40% of all pelvic floor surgeries are performed for the treatment of urinary incontinence.
With the help of a robotic system, effective organ-preserving surgeries are performed in women with uterine prolapse. Such procedures allow eliminating most of the symptoms, including urinary incontinence, difficulty urinating, pain during sexual intercourse, foreign body sensation in the vagina, pelvic pain, etc.
Robotic surgeries are preferable for retrocervical endometriosis. This is a form of endometriosis with localization of endometrioid foci between the cervix and rectum. Pathology manifests itself with pelvic pain, contact bleeding, pain during the sexual intercourse, and rectal bloody discharge during the menstruation.
Such surgeries are often performed in other forms of infiltrating deep endometriosis, when the foci of endometriosis grow into organs by more than 5 mm, cause symptoms or impair reproductive function. Robotic system allows removing pathological foci in the rectum, vagina, ureters, bladder and sacro-uterine ligament.
Using robot-assisted technology, surgeons successfully remove foci of endometriosis even in overweight women.
Advantages of robotic surgery
Robotic surgeries are the safest interventions that are well tolerated by patients. In terms of effectiveness, they are comparable to open surgical procedures or the "manual" laparoscopic procedures.
Robot-assisted surgery eliminates the factor of the surgeon's hands shaking. The robotic system makes movements precise and smooth. The volume of movements of the robot "hands" is greater compared to the hands of the surgeon. The visualization of the operating site is also better compared to laparotomy or laparoscopy.
After surgery, a woman feels better, recovers faster, has less need for pain medications due to mild pain syndrome, and can leave hospital earlier. Despite the longer duration of the robot-assisted procedure and its higher cost, it allows saving time and money, as a woman spends less time in the hospital and spends less money on the medical issues due to quick recovery in the postoperative period.
Treatment of gynecologic diseases in Germany with Booking Health
To undergo treatment of gynecologic diseases with the da Vinci robotic system in the world’s leading hospitals, you may use the Booking Health service. Booking Health is the only medical tourism operator that has been internationally certified in this area (ISO 9001: 2015 certificate).
With the help of Booking Health, you can compare the cost of surgeries in different clinics and book the desired medical program. Booking Health specialists take over the comprehensive organization of treatment abroad and help in such issues:
- Selection of a specialized hospital with wide experience in carrying out da Vinci robotic-assisted gynecologic surgeries
- Direct communication with the chosen physician
- Making the appointment at convenient dates
- Reducing the cost of medical services due to the additional fees exclusion
- Elaboration of a medical program without repeating previous examinations
- Independent control of all stages of the medical program
- Communication with the clinic after treatment completion
- Purchase and shipping of drugs and medical products
- Organization of additional diagnostics, rehabilitation or treatment abroad
Booking Health specialists provide high-quality service. They will book a hotel and air tickets for you, arrange transfer from the airport to the hospital and back. Leave the request regarding the treatment of gynecologic pathologies on the Booking Health website and a patient case manager will contact you the same day.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova