Robotic vs Laparoscopic Surgery in Benign Gynaecology: What Is the Difference?

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.

It depends on the age of the patient and her fertility desire. If it's a perimenopausal woman around 48 who has completed her family and has multiple fibroids, it's her choice whether she wants just the fibroids removed or the uterus removed too — sometimes women have very tiny peanut-sized fibroids we cannot take out at the time, and those can recur and regrow. So in many such women it's often better to think about getting the uterus removed rather than saving it. These are the kinds of discussions I'd have with the patient, taking them through the pros and cons of either, and then they can make a call.

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.

Robotic surgery offers around 15 times more precision than laparoscopy, along with superior 3D visualisation, which translates into less bleeding and a lower complication rate during the operation.

Around 90 percent of patients who undergo robotic removal of the uterus or a fibroid can go home within one day, compared with a minimum of two to three days after laparoscopic surgery and three to five days after open surgery.

Yes. Because of the precision robotic instruments allow, the rate of conversion to open surgery is reduced compared with laparoscopy, and operating time can even be shorter than the same procedure performed laparoscopically.

Patients undergoing robotic surgery tend to experience less post-operative pain and a lower readmission rate than those undergoing laparoscopic surgery for the same benign gynaecological conditions.