Robotic surgery has been around since the 1990s and has been used in multiple specialties to assist surgeons. The da Vinci™ surgical system from Intuitive Surgical is the market leading robot and gained predominance by its use in robot assisted radical prostatectomy for prostate cancer. In 2005, it gained approval from the US Food and Drug Administration for use in gynaecological surgery, and by 2013 gynaecology was the major user of robotic surgery worldwide. To date, over 5 million robotic surgery procedures have been performed worldwide.
The system allows the surgeon to be seated at an operating console and thereby to operate a 3D telescope and 3 operating arms that are inserted via keyhole incisions into the patient. The result is the best vision (3D, x10 magnification, full HD), the most precise instruments that have no tremor and are wristed more than a human hand, and advantageous ergonomics that result in the surgeon being less tired. The more complex the surgery, the more advantageous is the technology.
ROBOTICS IN ENDOMETRIOSIS SURGERY
Peter Barton-Smith began the first gynaecological robotic surgery programme in the UK at The Royal Surrey County Hospital in Guildford in 2009. He performed the first UK robotic surgery case for severe endometriosis and now has one of the largest case series worldwide. Peter published the largest series of robotic surgery cases for severe deep infiltrating endometriosis worldwide as part of an international group.
The advantage of robotics in complex endometriosis surgery is that it allows more accurate dissection around sensitive structures in the pelvis that are often involved in the disease, like the ureters, bowels and nerves (watch a da vinci robot assisted excision of severe deep infiltrating rectovaginal endometriosis)..
Most expert endometriosis centres using conventional straight stick laparoscopic surgery have reported major complication rates for recto vaginal endometriosis at around 7% when a shaving technique is used. The rates are higher when disc or full segmental bowel resection are employed. Half of these major complications are generally leaks from areas that break down on the bowel or ureters that occur within several weeks of surgery. Bowel leaks are particularly dangerous and generally require a temporary stoma for several months whilst they heal.
At The Endometriosis Clinic the main technique used for excising severe endometriosis is robot assisted shaving, and the major complication rate has been 2.5% (4 out of 162 as at July 2018 = cases). 0% of cases have so far had bowel or ureter leaks. The highest risk cases are those that have had multiple previous poor quality surgeries, or who have infection on top of their severe endometriosis. However, they are also the women who benefit the most from the technology as they are the most difficult cases.
Like any new technology, there is a premium to be paid for robotic surgery, and for complex surgery this is the only technique we now offer as the results have been so good.
See Fees and Procedures for more details.