Robotic surgery leads to shorter, easier recovery

For almost two years, Rosi Pazos suffered heavy menstrual bleeding and an assortment of aches and pains that left her spent by the end of her period. She sought help from several doctors before her gynecologic surgeon delivered the news.

Pazos, 48, the mother of an adult daughter, needed a hysterectomy to remove the large fibroids that were causing her bleeding and anemia. She didn’t hesitate.

“I just wanted it out of the way, so I could go back to my life,” she recalls.

Though Pazos was initially scheduled for a traditional laparoscopic surgery at South Miami Hospital in May, Dr. Ricardo Estape instead suggested a new procedure that he believed was better than the minimally invasive surgery her doctor and Estape’s partner, Dr. John Diaz, had recommended.

Approved by the U.S. Food and Drug Administration in February, the single-site robotic surgery promised even faster recovery time and less pain and scarring. Pazos would be Estape’s first single-site surgery.

“I trusted him completely, the way he described everything,” says Pazos, who lives in Miramar but works for a title company in Coral Gables. “I was happy to be the guinea pig.”

Pazos says she’s even happier now. Estape removed six or seven fibroids that weighed about 10 pounds. One of them was the size of a softball. Following the surgery, she never experienced pain and was back at work by the third week. In a traditional open hysterectomy, recovery is five to six times as long.

Estape is part of a select group of surgeons who received special training to perform this single-site surgery. During the procedure, the surgeon makes a small incision in the patient’s navel and then inserts a special port with four holes through that opening. One hole will house the camera, the other three the surgical instruments. With the help of the da Vinci robotic system, the surgeon sits at a console where he can view a 3-D, high-definition camera image of the surgical site, using hand controls to move the camera and instruments.

Patients are usually out of the operating room in about an hour and home the next day. “There’s no question that the particular group of patients who are candidates for this surgery are happier,” Estape says. “There’s a hidden scar, fewer complications and the recovery time is shorter.”

Some believe the assisting robot also gives surgeons more dexterity, precision and control.

Dr. Nicholas Lambrou, a gynecologic oncology surgeon at Mount Sinai Medical Center in Miami Beach, is also performing the single-incision robotic surgeries. “It’s a wonderful tool,” Lambrou says, adding that it is especially welcomed in the gynecological field, where patients are reluctant to take off too much time for recovery because of job and family responsibilities.

“A lot of women put themselves second,” Lambrou adds. “But with this kind of surgery the recovery is faster.”

Not all physicians are enthusiastic about robot-assisted surgery, however. Dr. Tarek Bardawil, assistant professor of obstetrics and gynecology at the University of Miami Miller School of Medicine, says, “I’m not a big fan of robotic surgery, certainly not of using things that increase costs unnecessarily.” He cited two recent studies that question the use of robotic surgery when conventional laparoscopic surgery — also a minimally invasive procedure in which surgeons maneuver specialized tools and a video camera by hand through several small incisions — is available.

In one, Columbia University researchers, publishing in the Journal of the American Medical Association earlier this year, questioned the benefit of using robotic surgery because of its increased costs. (The study did not include single-incision robotic surgery because it examined hysterectomies between 2007 to 2010, before the single-incision robotic hysterectomy was given the OK by the FDA.)

A JAMA editorial also urged hospitals and surgeons to be cautious about promoting robotic surgery without more evidence or a price drop.

Another study, at Cleveland Clinic in Ohio, compared patients who had hysterectomies either by laparoscopic or robotic surgery. The study found no significant differences in blood loss, pain or recovery between the two groups — but the robotic surgery did cost more.

Nonetheless, those using the new single-incision robotic surgery say the robotic tools can be easier to handle because they have “wrists” on the end that can be maneuvered in many ways. The robotic system also offers a 3-D view of the surgical site.

Lambrou points out that single-site robot assisted surgery isn’t for everybody or for all gynecologic conditions.

So far, the FDA has approved it for hysterectomies, oophorectomy (removal of the ovaries) and cholecystectomy (gallbladder removal). It has not been approved for cancer.

In addition, the mass to be removed cannot be large.

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