What Is Robotic Surgery? How the Robotic System Works in Gynaecology

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.

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.

A robotic surgery system consists of a surgeon console, where the surgeon sits and controls the instruments, a vision cart, which lets the rest of the surgical team follow the operation on screen, and the patient side, where the robotic arms carry out the movements made at the console.

The robotic system uses a 3D camera with 360 degree rotation, offering far greater clarity and depth than a standard laparoscopic camera, precise enough that a grape could be peeled using the robotic instruments in a demonstration.

The vessel sealer is a specialised instrument used when more bleeding is expected. It seals blood vessels quickly, reducing the need for blood transfusion during surgery.

Depending on the type of procedure, three or four robotic arms may be used, each translating the surgeon's hand movements into precise action inside the patient.