What is robotic-assisted surgery?

da Vinci robotic systemSince 2006, UC Davis’ gynecologic oncology surgeons have been performing minimally invasive procedures using a robotic surgical system. The device enables surgeons to safely treat several types of gynecologic cancers and other conditions. The surgical robot, with its precision-guided arms and video camera, is completely controlled by a trained surgeon who manipulates the mechanical arms from an operating-room console near the patient’s bed. Robotic-assisted surgery requires several small incisions rather than the larger opening of traditional “open” procedures, which can help reduce blood loss and postoperative recovery times.

How does robotic-assisted surgery work?

da Vinci hand controlsSimilar to laparoscopic surgery in that it is minimally invasive, robotic-assisted procedures use special equipment that includes an operating console for the surgeon, precision-guided robotic arms that are inserted through keyhole-sized incisions, and a small video camera that provides magnified, 3-D images of the gynecological site. The camera enables doctors to see the blood vessels, nerve bundles and organs (such as the bladder, rectum and ureters) adjacent to the operating area. The robotic arms, with full 360-degree rotation capabilities, allow surgical instruments to move with exactitude, flexibility and a range of motion that cannot be accomplished with standard laparoscopy.

Robotic-assisted procedures usually are done under general anesthesia. Most patients experience only a small blood loss and blood transfusions are uncommonly needed. Gynecology oncology patients typically spend one or two nights in the hospital and are usually discharged when they are able to tolerate regular food, walk without assistance, and have pain that is controlled with pain pills.


What are the benefits to a patient?

Patients typically experience significantly less pain and less blood loss than those undergoing conventional “open-incision” procedures.  Patients typically enjoy quicker recovery times.  Additionally, studies suggest that the robotic-assisted system provides surgeons with a superior tool that allows for the precise removal of lymph nodes during cancer operations, when compared to traditional open or minimally invasive approaches. The robotic system also allows your surgeon better visualization of the anatomy, which is especially critical when working around delicate and confined structures like the bladder, blood vessels and other internal organs. This allows surgeons to perform radical cancer surgeries and help overcome challenges associated with adhesions from previous operations.

Why is there less blood loss with robotic-assisted surgery?

The enhanced three-dimensional view with magnification can allow the surgeon to see blood vessels even more easily than is possible with open surgery.  This superior visualization along with precise movement of the surgeon-controlled robotic arms improves the ability to expose and control blood vessels adjacent to the surgical field.

Blood loss is also reduced because the pressure generated by the gas used to inflate the abdomen during surgery compresses small blood vessels, which provides surgeons with a better and more expansive view of the operating area.

What are the risks of robotic-assisted surgery?

incision comparison open surgery vs. robotic surgeryRobotic-assisted surgery is major surgery performed through small incisions.  It has the same kinds of risks that open surgery has including injuries to intra-abdominal organs.  There are risks of medical complications such as stroke, heart attacks and blood clots in the legs.  General anesthesia is generally very safe, but occasionally there are complications with this as well.

Use of small incisions for laparoscopy usually means less pain and discomfort compared to large abdominal incisions.  Therefore, robotic and standard laparoscopic surgery can minimize the risks of wound infections, pneumonia and blood clots in the legs, because only small incisions are required.

The benefits of any surgical procedure cannot be guaranteed.  Pre-operative assessment of a patient’s overall health is a key element in every surgical decision at UC Davis. Successful outcomes depend on both the patient and the procedure.  Patients should always discuss all the treatment options with their physician to understand the risks and benefits.

What are the patient criteria for robotic-assisted procedures?

Not all patients are suitable for robotic surgery. Severe medical problems and/or advanced age may mean that the patient cannot tolerate the special positioning and length of the procedure. Severe obesity is a common limitation, although robotic surgery can sometimes be successful when standard laparoscopy is not feasible. Severe intra-abdominal adhesions due to previous surgery may prevent a minimally invasive approach. UC Davis’ surgeons will discuss your treatment options and help you decide the best course of action.

What about long-term follow-up from robotic-assisted procedures?

Follow-up care depends on the condition being treated. Most patients who undergo a robotic-assisted procedure usually have one or two post-operative visits, unless there are complications. If the patient has cancer, follow-up visits to monitor the patient for a possible recurrence is standard care (but is no different than with standard abdominal surgery). Patients may or may not need additional cancer treatments, depending on the pathology report following surgery. Your physician will develop a post-operative action plan for you.