Robotic Surgery

Para leerlo en español, clic aquí

Remember, the information on my website, podcast, Instagram, and any other ways I communicate and/or produce content is educational information only and not medical advice. Always check with your qualified medical professional before making any changes to your treatment plan for endometriosis or any other health problems. See my full disclaimer here.

Robotic surgery is still just laparoscopy

Excision surgery can be via:

• robotic surgery
• standard laparoscopy (minimally invasive surgical procedure using small incisions)

Both techniques can potentially give the patient a good outcome with low complication rates. What’s most important is not if it’s robotic or standard laparoscopy, but rather the surgeon’s ability to recognize endometriosis in all its colors, appearances, and locations, and to safely excise it from all locations.

• There are excellent excision surgeons with great patient outcomes and low complication rates who use the robot

   

• There are excellent excision surgeons with great patient outcomes and low complication rates who use standard laparoscopy

“Robotic surgery is still just laparoscopy. That is the first hurdle that needs to be understood. There is nothing magical about the robot, but there are many benefits to robotic surgery in comparison to standard laparoscopy. Patients have stated that they did not want robotic surgery, because they wanted the surgeon’s hands “doing” the surgery. Even in laparoscopy, the surgeon does not touch the tissue with his hands. The surgeon uses instruments, and often the same type of instruments as standard laparoscopy, to perform the surgery.” [Quote from Dr. John Dulemba, excision surgeon via his article Robotic Surgery]

Some advantages of robotic surgery vs standard laparoscopy for endometriosis

Dr. John Dulemba has done over 5,000 standard laparoscopic surgeries and over 2,300 robotic surgeries for endometriosis. In his expert opinion, some advantages of the robot vs standard laparoscopy for endometriosis are: 

• The surgeon’s comfort when operating, reducing their fatigue. This can be especially important during long, complex excision surgeries.
• Better visualization. Davinci robot is 3D versus 2D for standard laparoscopy: “This helps with dissection, excising endo, and separating organs and adhesions.”

Is the loss of haptic touch a problem with robotic surgery?

“A complaint [about robotic surgery] is that there is a loss of tactile sense (touch and feel). Over time, the brain adapts, and the surgeon seems to develop a visual tactile sense. I can detect soft and hard tissue. The visual tactile sense allows me to be as gentle as normal hands and laparoscopic hands.” [Dr. Dulemba]

Dr. Jeff Arrington is an excision surgeon who has done both standard laparoscopy and robotic surgery, and has been doing robotic surgery for the last 12 years. In his Instagram post on 1/2/23, he said:

“[Loss of haptic touch] doesn’t limit a good robotic surgeon’s ability to identify deeper margins of disease or even deep disease. When one sense is taken away, our brains adapt! With robotics I still use vision, grasping strength, tissue mobility, and visual comparison of areas to detect deep endometriosis.”

The robot is just a tool

It’s not about the tool – it’s about the surgeon using that tool and their skills. It doesn’t make or break your surgery, or mean that you will have any better or worse surgery because of it. However, if the surgeon does robotic surgery, it’s important to know that using the robot is also a skill in itself, and it can take anywhere from 50-150 surgeries for a surgeon to become skilled at using the robot, depending on how much surgical experience the surgeon has prior.

Ask your surgeon questions to gauge their skills:

• What kinds of complications have they had?
• What are their patient outcomes?
• What kind of training in excision do they have?
• What kind of training in using the robot do they have?
• How many excision surgeries have they done?
• How many excision surgeries have they done using the robot?

Remember, not all excision surgeons have the same skill level or experience. 

There are multiple small studies evaluating safety and efficacy of robotic surgery for endometriosis

They show that robotic surgery and standard laparoscopy have:

• comparable perioperative outcomes
• comparable intraoperative and postoperative complication rates (no evidence of increased complication rates for robotic surgery)
• similar quality of life improvements post surgery