Open, Laparoscopic or Robotic Surgery: How Doctors Choose

People who train in robotic surgery are mostly already laparoscopic surgeons who've done many laparoscopic surgeries — very few robotic surgeons are 'de novo,' never having done laparoscopic surgery. If you've driven a manual car and now you're going to an automatic, proficiency comes sooner — you just need to learn to drive the robot. On conversion: I had one case in the last three to four years where I had to open a patient up, purely because during robotic surgery the patient's head is at a 30-degree angle, quite low down, and there was a lung compromise issue — the patient wasn't able to maintain oxygen saturation. We tried undocking the robot and raising her head, waited ten minutes and restarted, but her saturation kept dropping, so we had to open her up. That's the only case I can recall in three years, out of several hundred surgeries — patient selection is the most important thing.

With God's grace, none of my patients have ended up in the ICU or anything like that — they've all recovered beautifully. I've done more than 400 to 500 robotic surgeries so far, and I cannot recall any complications in terms of injury to the bladder, bowel, or ureter — essentially a 100% success rate at the post-operative stage.

It depends what's meant by 'failure rate' — conversion to open surgery, complications, or the surgery not being viable at all. On not being viable: if you're an expert in robotic surgery, you should be able to make that decision pre-operatively through proper planning — getting an MRI or CT done if the ultrasound report isn't satisfactory. On complications: the risk of injury is less than 1% with robotic surgery — for bowel and vessel injury specifically the risk is less than 0.5%, and bladder injury is similarly low, compared with 1 to 2% with laparoscopic surgery.

Artemis has been very proactive with all sorts of expansion, and is very much into the international world — we're there to support it. With the new digital world, things like today's Zoom session can happen, and I'll be very happy to be part of any travel needed, taking time out every couple of months to be with the doctors and patients there. I'm a very proactive person when it comes to teaching and training, because the skills we've acquired are good to spread around so more people can gain the expertise.

Robotic surgery is a little more expensive than laparoscopic surgery — depending on the type of surgery, somewhere around $1,000 to $1,200 extra than any conventional laparoscopic surgery.

If a fibroid or uterine mass is very massive, roughly 4 to 5 cm above the level of the belly button or higher, there may be no space to safely place the camera or manoeuvre instruments, making open surgery the necessary option regardless of available technology.

For a uterus around the size associated with an 18 to 20 week pregnancy or larger, laparoscopic surgery becomes technically tricky, which is where robotic surgery often becomes the preferred alternative.

Afro-Caribbean and African women are particularly prone to fibroid uterus and often present with multiple fibroids, a pattern that generally means they benefit more from robotic surgery than from laparoscopic surgery alone.

Cases of severe endometriosis with significant adhesions, along with patients with multiple fibroids, are better suited to robotic surgery because of its far greater precision compared with standard laparoscopic techniques.