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Robotic Surgical Services: Linda Del Monte
Registered nurse Linda Del Monte was one of those people, but when she started having abnormal bleeding after menopause, she knew she needed to see her gynecologist right away. She thought she knew what the doctor would tell her, but even as a registered nurse and clinical marketing manager for a medical electronics manufacturer, she wasn't ready for the diagnosis.
What Del Monte thought was a minor problem actually was an endometrial polyp with complex atypical hyperplasia. In other words, she had a large, pre-cancerous growth in her uterus that would require a total hysterectomy – the complete removal of the uterus, ovaries and fallopian tubes. Del Monte thought back to patients she had nursed after they'd had this surgery, and her heart sank.
"My first reaction was, I won't be able to work for weeks!" Del Monte recalls. "I knew that recovering from a traditional hysterectomy can be uncomfortable. I expected a long recuperation, not being able to even work from home and needing a lot of help."
Just as the busy Magnolia woman began to dread the challenge ahead, her gynecologist followed the bad news with some good news: Del Monte might be a good candidate for robotic surgery.
The da Vinci S robotic surgical system used at Northwest Hospital & Medical Center consists of a console, where the surgeon sits, and the robot itself, which is equipped with four flexible arms. Controlled by the surgeon at the console, the robotic arms do everything needed in a laparoscopic surgical procedure, from controlling the miniature camera to manipulating surgical tools. Dr. Kathryn McGonigle, a gynecologic oncologist at Women's Cancer Care of Seattle, and an expert at robotic surgery, speaks of the technology with enthusiasm. "The surgeon looks into a viewer in the console, which provides a three-dimensional view of the interior of the patient's abdomen. From the console, the surgeon also controls the robotic arms using natural finger and wrist movements. A foot pedal is used to "clutch" different instruments. The surgeon controls the entire surgical field while sitting several feet away from the patient."
According to Dr. Howard Muntz, Del Monte's surgeon, robotic surgery has several benefits over standard laparoscopic surgery, in which a surgeon uses a camera and other tools introduced into the body through small incisions. "With robotic surgery, you don't have an assistant holding the camera, getting tired and accidentally moving the camera, which makes everyone a little seasick as they try to complete the surgery," he explains. "Also, with regular laparoscopy, the instruments are rigid, like giant chopsticks. With the robot, you can manipulate special flexible instruments within a stable visual field to make your movements even more accurate."
Thanks to computer technology, the robot miniaturizes and mimics the surgeon's hand movements, while minimizing any hand tremor. "The fingers of the robot work in tight areas at your direction, often better than you can do it with your hands in an open procedure," Dr. Muntz notes.
As she learned more about robotic surgery, Del Monte was intrigued by the surgeon's ability to do major pelvic surgery through small abdominal incisions. That's due in large part to the improved visual field the da Vinci system provides. "The binocular camera lenses on the surgical console become your eyes, allowing you to get right on top of what you're working on," Dr. Muntz says. "Visually, you can be inches away from a delicate structure, seeing with three-dimensional vision every little blood vessel and nerve. You can then do the procedure with absolute precision."
What shocked Del Monte, though, was how she felt after the robotic surgery. Her bedside experience as a post-operative nurse caring for abdominal surgery patients who had undergone traditional procedures had prepared her for a difficult recovery at best. Instead, Del Monte went home the day after surgery, rather than having to stay in the hospital. "I felt pretty good – not at all like you would expect," Del Monte says.
Dr. Muntz credits a large part of Del Monte's high degree of comfort to the fact that robotic surgery makes it easier for the surgeon to work deep in the pelvis without excessive force or tissue trauma. "That translates into a safer procedure, with less blood loss. The robotic surgical times can also be much shorter than either conventional laparoscopy or open surgery, which means less time under anesthesia and less time on the operating table," he says. "People can feel stiff and sore from being on the hard table for hours, so shorter surgeries often mean more comfortable recoveries."
Del Monte actually felt so well a day after surgery that she even gave a little dinner party – and that was after she went for a walk around the neighborhood. In the weeks that most open surgery patients would spend on the couch, Del Monte attended a conference in Chicago (ten days after surgery), worked from home and even swept out the basement.
Del Monte says she was surprised that more people didn't know about the availability of robotic surgery for gynecologic conditions and cancers. The explanation is simply that the procedure is very new. While robotic surgery was approved by the Food & Drug Administration for prostate surgery seven years ago, the use of the robot for gynecologic procedures only dates back to 2006. Dr. Muntz says, "Currently there are only a handful of surgeons in the Seattle area qualified to do gynecologic robotic surgery and several are at Northwest Hospital." These surgeons have completed specialized training to be able to use the da Vinci S system.
Not everyone is a candidate for gynecologic robotic surgery. Dr. McGonigle points out that each case must be evaluated individually. "In some cases, the tumor or uterus may be too big to be safely removed either robotically or laparoscopically, and open surgery may be required. For those who are robotic surgery candidates, such as those with uterine cancer, for example, da Vinci is an excellent tool." "It's also a good tool for patients who are significantly overweight, where surgery is more challenging," Dr. Muntz adds. "In a complex surgery, such as a cancer operation, the robotic technology allows us to do safe, minimally invasive surgery, rather than putting an obese patient through the rigors of open surgery."
For more information on the da Vinci robot, visit www.davincisurgery.com.