Are women aware of gynaecological robotic surgery? How are robot-assisted gynaecological surgeries gaining popularity in India?

Dr Shafalika SBThursday, March 9, 2023, 08:00 Hrs  [IST]

One of the most recent developments in minimally-invasive surgical methods is gynaecological robotic surgery. A variety of diseases that affect a woman's reproductive system can be tackled by the use of a small, illuminated scope and tiny devices operated by a robotic system. In India, gynaecological robotic surgeries are not widely known to the public. According to reports, less than 10 per cent of the population is aware of gynaecological robotic surgery and its benefits. While, to some extent, gynaecological cancers are treated through robotic surgery, it is still not widely used in the case of benign tumour surgeries.

Various conditions where gynaecological robotic surgery is needed
Robotic surgeries are used in procedures that need extensive and intricate suturing, such as complex myomectomy and advanced endometriosis with a frozen pelvis, abdominal pain, as well as surgery for malignancies like endometrial cancer or cervical cancer, and mesh repairs for wall prolapse surgeries, prolapse surgeries, or tubal recanalization surgeries. Other than that, more common surgeries that include robotics are for endometriosis and fibroids.

Advantages and benefits
Similar to any minimally-invasive surgery, the benefits of robotic procedure include smaller incisions that result in decreased morbidity, less postoperative pain, and shorter hospital stays. Robotics do appear to have advantages in more complex treatments where thorough dissection and accurate anatomical reestablishment are necessary.

Compared to laparoscopic surgery, robotic surgeries are certainly easier. Despite the fact that many different types of robots are being developed, only the tried and tested ones are safe and recommended for use. Therefore, before performing any surgery, it is crucial to understand the suitability of the robot on the basis of testing. If the treatment is carried out laparoscopically, there are no discernible benefits for the patient in terms of robotic surgery. However, in the case of open surgery, robotic surgery is distinctly beneficial.

Furthermore, compared to open procedures, robotic surgeries clearly provide greater benefits to both, patients and doctors, because the learning curve in laparoscopic surgery is very steep and prolonged, whereas in the case of robotic surgeries, it is short and much easier for surgeons to comprehend. In addition, there is certainly less blood loss, less discomfort, and much faster recovery when compared to open surgeries. However, robotic and laparoscopic surgeries are nearly equivalent. As more companies introduce robots, it is anticipated that the number of robotic surgeries will rise in the coming years. The two issues hampering this are the cost and insurance acceptance. So, if the cost aspect is addressed, and insurance firms provide more acceptance and claim approvals, there will undoubtedly be growth in robotics.

Another benefit of robotic surgery is the comfort of the doctor while performing the surgery. In this case, the doctor is usually less stressed while performing the robotic surgery and can easily perform the surgery with the help of 3D vision and user-friendly instruments, which make complicated surgeries easier, and cause less pain. Additionally, robotic procedures are more effective and faster than conventional surgeries.

Need for robotic surgery
When performing surgery to remove fibroid tumours, a robot provides substantially higher levels of suturing accuracy. Suture placement is the most challenging aspect of any surgery. And this can be very well accomplished through robotic surgery.

Robots also assist doctors in getting into better planes when treating endometriosis because separating the anatomical structure in this condition is quite challenging, and the 3D vision of the robot helps in better reaching the particular site. Also, these surgeries are more precise, meticulous, less painful, and involve less blood loss.

Robotic surgeries are strongly advised for those suffering from multiple fibroid tumours or where a tumour is situated in a tricky position requiring complex suturing. Robotic surgeries are also highly recommended in advanced cases of endometriosis, advanced prolapse surgeries, and cancer surgeries.

Thanks to these positive aspects of robotic surgery, more surgeons are now being encouraged to practice robotic minimally-invasive surgery.

Robot-assisted gynaecological surgery is not required for every patient. The majority of cases are resolved laparoscopically and result in comparable surgical results. Some gynaecological treatments, such as the prolapsed uterus, can even be handled vaginally and do not need robotic or laparoscopic equipment. Therefore, the kind of surgery that should be recommended to the patient and which will result in the best surgical outcome is determined by a clinical assessment of the case and the problem at hand.

How are robotic-assisted gynaecological surgeries gaining prominence in India?
Robotic-assisted gynaecological surgery is gradually gaining popularity in India, as it is slowly pushing aside the limitations of traditional laparoscopy, giving access to minimally-invasive procedures. A few years back also, gynaecological robotic surgery was not popular in India. That was because there was scepticism among the patients that the surgery might end up badly or result in complications. However, in recent years, many women have successfully gone through robot-assisted gynaecological surgery. This has helped the procedure gain acceptance and prominence.

Previously when we used to recommend robot-assisted gynaecological surgery to patients they used to deny it. It took a lot of effort by us to raise the level of awareness among patients and to assure them that while the robot does the complicated treatment process, it is the doctors who control them indirectly.

A few years ago, women were largely unaware of robot-assisted surgeries. However, times have changed. With the technology gaining popularity, women are understanding the benefits of this procedure, and are now increasingly opting for it. Naturally, as upgrades of the technology enter the market, its popularity and acceptance will only grow.

Finally, for patients suffering from gynaecological issues or going through robot-assisted surgeries, it is important that they undergo regular check-ups and maintain a healthy routine.

(Author is consultant, Minimally Invasive Gynecology, Manipal Hospital Yeshwanthpur and Hebbal)