Global Health Asia-Pacific Issue 2 | 2023 | Page 90

Robotic surgery in gynaecology :

A safe and available option for women

Minimally invasive surgery ( MIS ), or keyhole surgery , has been widely used over the last two decades . Now the gold standard and a preferred route in many gynaecological operations , it has replaced open abdomen surgery for benign gynaecological conditions . Its proven benefits include smaller incisions , minimal pain , an earlier return to normalcy , and less risk of wound infection and adhesion formation .

Robotic-assisted keyhole surgery in gynaecology is an extension of MIS . Its use has been refined and expanded in recent years due to advances in robotic technologies . Based on the current incremental deployment rate of the robotic system across hospitals worldwide and in Southeast Asia , it has gained more traction with increased popularity amongst gynaecologic surgeons . This growing trend has also been attributed to advanced training opportunities and a shorter learning curve to master robotic surgery , especially for inclined endoscopic surgeons . Compared to a conventional keyhole and open abdomen surgery , robotic surgery provides an excellent 3-dimensional view of the operating field , as well as precise wrist-like movements of the robotic instruments , miming the intricate manoeuvres of human hands . Together , these offer the surgeon greater control of the surgery , minimising hand tremors and providing greater precision , accuracy , and enhanced safety during surgeries . These advantages are paramount for gynae-oncologic and fertility preservation surgery . In the hands of learned and experienced robotic gynaecologic surgeons , the available data consistently reports minimal blood loss , fewer complications , shorter hospital stays , and , most importantly , enhanced patient comfort , especially after oncologic surgery compared to conventional surgery .
What gynaecologic surgery is best performed robotically ? Technically , all spectrums of gynaecologic procedures for laparoscopic surgery can be done robotically , benefiting all women . However , due to its financial implications ( higher cost ), there are some reservations and considerations in case selection .
Dr Sharifah Halimah Jaafar is a Consultant Obstetrician & Gynaecologist , Endometriosis Specialist , Minimal Access & Robotic Surgeon at the Gleneagles Hospital Medini Johor .
Robotic surgery could be considered a highly safe option and a more cost-effective surgical tool than conventional keyhole surgery for women who have to undergo complex gynaecology surgery , which requires higher technical precision , especially in cases of severe or deeply infiltrating endometriosis , uterine fibroid with fertility preservation , deep pelvic surgery , complex hysterectomy , and surgery for gynaecological malignancy . It has also been proven beneficial for those with associated medical issues or comorbidities , such as morbidly obese patients with a body-mass index ( BMI ) of more than 30 kg / m2 or patients with underlying lung problems . The application of robotic-assisted surgery in such cases has reduced both the numbers of traditional open surgery and the risk of conversion to open surgery from traditional keyhole surgery ; both should be considered when performing a cost-benefit assessment of using the robot .
What does this news mean for women and women ’ s healthcare ? Fear of pain and surgical complications , loss or reduced productivity after surgery , and limitations in daily functioning after open abdomen surgery are among the most common reasons for hesitancy and delays in undergoing a needful surgery in many women . Such indecisiveness might affect the prognosis and impair the overall outlook of their illness , particularly for those diagnosed with malignant conditions requiring earlier surgery and others where fertility preservation is concerned . The enhanced safety and greater performance at surgery offered by minimal access and robotic technology could allay the fear and increase confidence in some women when making timely healthcare decisions .
�epending on the affordability and accessibility of facilities and the skillset of surgeons , the addition of robotic surgery in the armamentarium of gynaecological surgery now provides women with more expansive options for minimal access and safe surgery should they require gynaecological surgery for benign or malignant conditions .
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