Question 1

What is the cost implication of robotic surgery compared to laparoscopic or open surgery?

Dr. Deepika Aggarwal · Accepted Answer

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.

Question 2

With robotic surgery, is there no indication for hysterectomy in women with fibroids?

Dr. Deepika Aggarwal · Accepted Answer

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.

Question 3

Proficiency for complex robotic cases like endometrial cancer may be reached in fewer than 10 cases, compared to 40 for standard laparoscopy — what is your comment on this? And have you had to convert to open surgery?

Dr. Deepika Aggarwal · Accepted Answer

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.

Question 4

How many robotic surgeries have you done in your career, and what was the success rate including post-operative recovery?

Dr. Deepika Aggarwal · Accepted Answer

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.

Question 5

What is the failure rate in robotic surgery?

Dr. Deepika Aggarwal · Accepted Answer

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.

Question 6

What are your plans to expand training so more gynaecologists in developing countries like Ethiopia can become expert in robotic or laparoscopic surgery?

Dr. Deepika Aggarwal · Accepted Answer

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.

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