Ask the Expert: Robotic Gynecologic Surgery

If your doctor recommends hysterectomy or surgery to treat another gynecologic condition, you may be a candidate for da Vinci® robotic surgery. More and more women are discovering the benefits of this less invasive surgery. Dr. Kris Ghosh, MBA, is a gynecologic oncologist affiliated with Sharp Grossmont Hospital, and one of the experienced surgeons specially trained to perform surgeries using the da Vinci Robotic Surgical System. He answers questions about this revolutionary treatment.

How does da Vinci hysterectomy differ from traditional surgery?
Da Vinci surgery differs from traditional surgery in that we surgeons work at a console rather than standing directly above the patient. In addition, da Vinci surgery is minimally invasive. Small incisions are made, through which very small instruments are passed to perform the surgery. Robotic surgery uses technology that allows our hand motions to translate into extremely precise movements within the operative site. The magnified, three-dimensional view and small, robotic instruments enhance our ability to perform complex and delicate procedures through small incisions.

Besides hysterectomy, what are other common gynecologic conditions that can be treated with robotic surgery?
Besides the hysterectomy, which is the most common gynecologic surgery (about 600,000 cases per year), the myomectomy, where uterine fibroids are removed while preserving the uterus, is a surgery utilizing the unique aspects of the da Vinci system. In cases of genital prolapse, where the uterus or vagina starts to descend and literally fall out, the sacral colpopexy procedure benefits from robotic surgery. In this procedure, the vagina is suspended with a sling. Robotic techniques are also very successful when used in gynecologic cancer surgeries to treat endometrial cancer or radical hysterectomies for cervical cancer.

Are the outcomes different in da Vinci (laparoscopic) surgery versus traditional, open surgery?
Open surgery is more painful than the less-invasive laparoscopic procedures. Open surgery requires a longer, more painful recovery, and more postoperative limitations when compared to laparoscopic surgery. In addition, laparoscopic surgery offers less bleeding, lower rates of infection and lower rates of postoperative adhesions than traditional open surgery.

How safe is da Vinci, and are there any disadvantages?
Da Vinci surgery has been in existence for many years, with many kinds of surgeries being performed. It is extremely safe, with no disadvantages.

What physical limitations will I have after the operation, and when will I be able to resume activities such as working, driving and exercise?
The restrictions after surgery depend on the nature of the surgery and the patient. In most cases, patients return to work in two to four weeks with minimal restrictions, and people resume most exercise in the same period of time. Although recovery is quicker with robotic surgery, patients will still experience a measure of fatigue that is associated with surgery in general.

How soon can I expect to be able to have sexual relations after surgery?
In regards to sexual activity, after myomectomy, I recommend two weeks of abstinence, and four weeks of abstinence with both hysterectomy and colpopexy.

Does da Vinci cost more than traditional surgery, and does insurance cover it?
Most insurance companies cover robotic surgery as it is not an experimental procedure. The cost to the patient is the same as traditional surgery. As robotic surgery becomes more widespread, it will become the standard of care in many areas of gynecologic surgery.

For More Information
To learn more about Sharp's robotic surgery services in San Diego, register for a free robotic surgery seminar. To find a Sharp-affiliated physician performing robotic surgery, call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm.