Clinical Briefing:
Robotic Surgery for Gynecologic Conditions and Cancer
November/December 2008
Physicians in the department of Obstetrics and
Gynecology at Penn are now using the latest
robotic surgical
systems to treat gynecologic
disorders and cancers, as well as to repair and
reconstruct pelvic organs and support tissue. These
procedures complement the growing presence of
robotic surgery at Penn in a variety of areas.
Robotic surgery offers physicians
an alternative to laparatomy or open procedures typically
used for radical hysterectomy or myomectomy, and a variety
of advantages over conventional laparoscopic
surgery. These include greater visual acuity via realtime
three-dimensional imagery in high magnification
and greater operative efficiency as a result of
substantial reductions in tremor and the use of
multiple robotic arms.
For patients, the benefits of robotic surgery
include diminished blood loss, fewer post-surgical
complications, reduced hospital stay and shorter
recovery time. Patients may resume their normal
activities in one to three weeks and report decreased
post-operative pain.
Robotic Gynecologic Surgery at Penn
Robotic surgery is being
performed at Penn to treat the following gynecologic disorders:
- Uterine
cancer
- Cervical cancer
- Endometrial cancer
- Adenomyosis
- Endometriosis
- Leiomyomas
In addition, the following reparative procedures
are performed via robotic surgery at Penn:
- Uterus-preserving
myomectomy
- Sacrocolpopexy
- Pelvic floor reconstructive surgery
- Tubal anastomosis
Two views of a robotic-assisted
laparoscopic uterine myomectomy
recently
performed at Penn.
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Robotic Surgery for Gynecologic
Cancer
The spectrum of robotic gynecologic
surgeries at Penn includes robotic surgery
for women needing surgery for
endometrial or cervical cancers, as well
as for some uterine cancers. Typically,
women undergoing robotic-assisted
surgeries for gynecologic cancer
experience shorter recovery times, less
pain and better cosmetic results than do
women having traditional open surgery.
Robotic Surgery for Fertility
Surgical approaches to restore
fertility such as tubal anastomosis and
myomectomy are also amenable to
robotic-assisted surgery. Robotic tubal
anastomosis is less invasive than a
standard microsurgical approach and
offers patients an opportunity to conceive
naturally following surgery.
Case Study
A 47-year-old female, presented at the department of Obstetrics
and Gynecology at the Hospital of the University of Pennsylvania for a
second opinion after her primary gynecologist recommended an
abdominal hysterectomy via a midline incision to treat pelvic pressure
and pain, presumably due to fibroids. At presentation, she reported
heavy vaginal bleeding accompanied by large clots with a substantial
decline in quality of life. On previous ultrasound, the uterus measured
15 cm by 8.5 cm by 10.2 cm.
At Penn, a pelvic exam confirmed an
enlarged uterus at 15 to 16 weeks size with a large, bulky
anterior component consistent with a solitary fibroid. After
counseling about the surgical and non-surgical treatment
options for fibroids and menorrhagia, the patient opted for
a laparoscopic hysterectomy.
"Robotic-assisted
surgery represents part of an evolution of innovations
at Penn for women requiring gynecologic procedures," said Mathew
N. Beshara, MD. |
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Upon initiation of surgery,
traditional laparoscopy of the operative field revealed limited
access to the uterine vessels. To avoid conversion to open
laparotomy, the robotic surgical system was moved into position
and docked to the patient. Dilute vasopressin was injected
into the myometrium overlying the large fibroid (9 cm), which
was enucleated from its casing and removed from the operative
field within 25 minutes.
Significant debulking of the uterus
as a result of this approach permitted the uterine vessels
and attachments to be visualized and dissected. A total laparoscopic
hysterectomy was performed in one hour, during which the
uterus and fibroid were morcellated to a manageable size
and the remaining tissue withdrawn vaginally. The vaginal
cuff was then closed laparoscopically. Total operative time
was 2.5 hours. Estimated blood loss was under 100 mL.
Our Team of Faculty
The Department of Obstetrics and Gynecology at Penn has a long tradition
of excellence in patient care, research in women's health and reproduction, and
residency and fellowship training. The department faculty represents a variety of
specialties, including general obstetrics and gynecology, maternal fetal medicine,
reproductive genetics, gynecologic oncology, reproductive endocrinology and
infertility, and urogynecology and pelvic reconstructive surgery.
Performing Robotic Gynecologic Surgery at Penn
Penn's robotic gynecologic surgery program is one of the largest in the
nation. Members of the gynecologic surgery program currently performing
robotic surgery include:
Gynecology
Mathew N. Beshara, MD
Assistant Professor of Clinical Obstetrics and Gynecology
Sharon
Y. Byun, MD
Assistant Professor of Clinical Obstetrics and Gynecology
Peter
J. Chen, MD
Assistant Professor of Clinical Obstetrics and Gynecology
Catherine
R. Salva, MD
Assistant Professor of Clinical Obstetrics and Gynecology
Urogynecology
Lily A. Arya, MD, MS
Assistant Professor of Obstetrics and Gynecology
Meghan
O. Schimpf, MD
Assistant Professor of Clinical Obstetrics and Gynecology
Fertility
Samantha M. Pfeifer, MD
Associate Professor of Obstetrics and Gynecology
Gynecologic Oncology
Thomas C. Randall, MD
Associate Professor of Clinical Obstetrics and Gynecology
Locations
Patient appointments are available at:
Department of Obstetrics and Gynecology
Hospital of the University of Pennsylvania
5 Penn Tower
3400 Spruce Street
Philadelphia, PA 19104
Penn
Fertility Care*
3701 Market Street
Philadelphia, PA 19104
Penn Health for Women
Penn Medicine at Radnor
250 King of Prussia Road
Radnor, PA 19087
Pennsylvania Hospital
801 Spruce Street
Philadelphia, PA 19107
*Fertility Care also available at Pennsylvania
Hospital and
Penn Health for Women
To refer a patient and/or consult
with a doctor, call 800-789-PENN (7366)
or refer
a patient online.
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