Minimally Invasive Surgery

Surgery has often been associated with negative connotations:  pain, scarring, lengthy hospital stays and long recuperation periods.  Recent advances and improved technology now help minimize some of this discomfort and inconvenience.  Many surgical procedures that have traditionally been performed through large incisions can now be completed with several minute incisions with the aid of cameras, computers and a robot. 

This new trend, called “minimally invasive surgery”, has revolutionized the surgical field.  Recovery is faster, pain is minimized, hospital stays are shortened and return to daily activities happens at a faster pace. 

Many gynecological procedures can be done with a minimally invasive surgical approach.  Laparoscopy was first used by gynecologists as a diagnostic tool for various female reproductive system related problems.  Laparoscopy evolved with time from a diagnostic tool to an operative technique.  The gynecological surgeons started out with simpler procedures, such as tubal ligation, and have since advanced to perform surgeries to treat major benign and malignant gynecological conditions.

Traditional laparoscopy entails inserting a small endoscope through a 1-2 cm long incision in the abdominal wall.  The original procedure involved looking directly through this scope to evaluate the pelvic organs.  As technology has advanced, these endoscopes have been attached to a high resolution camera and images are now displayed on monitors.  This has resulted in simplified training, more ergonomic set-up and keeps the entire surgical team involved in the procedure.  A wide range of gynecological surgical procedures can be carried out through this technique. 

In January, 2007, Henry Ford Wyandotte Hospital added a state of the art, minimally invasive surgical tool called the daVinci Surgical System to its armamentarium.  This System offers all the advantages of laparoscopic surgery with the benefit of superior 3D visualization, greater precision and a more ergonomic environment for the surgeon. 

The daVinci Surgical System consists of an ergonomically designed surgeon’s console, a patient-side cart with four interactive robotic arms, the high-performance InSite Vision System and proprietary EndoWrist Instruments.  Powered by state-of-the-art robotic technology, the surgeon’s hand movements are scaled, filtered and seamlessly translated into precise movements of the EndoWrist Instruments.  The net result:  an intuitive interface with breakthrough surgical capabilities.  The System replicates the surgeon’s movements in real time.  It cannot make decisions on its own to move in any way or perform any type of surgical maneuver without the surgeon’s input.  This “intuitive” motion is a dramatic improvement over traditional laparoscopic surgery, which requires specialized talent and training.  Laparoscopic surgeons operate with long-shafted, non-wristed instruments, which is similar to using a single chopstick or knitting needle in each hand.  In contrast the daVinci System can provide dramatically better dexterity, control and precision, allowing surgeons to use a minimally invasive approach for complex procedures.  

Surgeries are performed in the hospital setting and most patients are able to go home the next day.  Besides a shorter hospital stay, other potential benefits of minimally invasive surgery include less pain, faster recovery, quicker return to normal activities, less blood loss and minimal scarring.  Commonly performed gynecological surgeries performed with this technique are hysterectomy and myomectomy. 

Minimally invasive surgery (MIS) carries all the potential risks of conventional surgery.  Many gynecologists and surgeons are using this technique for the benefit of the patients.  It is imperative that the decision to have the surgery as well as the method of the surgical procedure be decided between the patient and her physician.  As with any medical decision making, all options, risks and benefits of the proposed treatment must be explored in advance.

Mohinder P. Singh-Sandhu, M.D. has been trained to use the daVinci Surgical System at Henry Ford Wyandotte Hospital.  The recent addition of the daVinci Surgical System has broadened our surgical capabilities for MIS.