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Robotic Surgery using the da Vinci Surgical System

Da Vinci robotic surgery is the most advanced surgical technology available today. It represents the culmination of decades of scientific and surgical innovation. Robotic surgery is the ultimate form of laparoscopic minimally invasive surgery. Using the Robot, surgeons are able to perform most surgical procedures through small incision on the abdomen instead of using a traditional laparotomy (large abdominal incision).

 

Dr. Farnam is one of the most highly trained da Vinci surgeons.  In 2002, he participated in the original trials of robotic surgery in gynecology at the Cleveland Clinic Foundation, and is one of the first gynecologists in the country to use the technology.  When da Vinci became available in El Paso in 2007, Dr. Farnam was one of the first surgeons to use robotic technology locally.  To date Dr. Farnam has performed more than 1,000 Robotic surgeries in El Paso, and is a national Epicenter Surgeon. Dr. Farnam has presented his research on robotics at multiple national conferences.  His innovations have made El Paso nationally relevent in the field of Robotic Gynecologic Surgery.

Frequently Asked Questions:

How is 'da Vinci' Surgery different?

Dr. Farnam using the da Vinci Robotic SurgeryConventional gynecologic and general surgery is performed through a 8-12 cm incision on the abdominal wall.  This large incision allows for excellent visualization of the operative field and permits surgeons to operate on the pelvic and abdominal organs with direct contact.  The disadvantage of conventional surgery is that the patient is left with a large abdominal scar, has a long hospital stay, increased pain, and prolonged recovery.

Laparoscopic surgery is performed through small keyhole incisions on the abdomen.  A small telescopic camera (laparoscope) is placed through the belly button (umbilicus) and allows for indirect two-dimensional visualization of the entire abdomen and pelvis.  Surgery is performed with long narrow instruments that are placed through other small keyhole incisions on the abdominal wall.  The end of the instrument (distil tip) can open, close and rotate, but does not provide any additional range of motion.  Because of these limitations, laparoscopic surgical proficiency in complicated procedures is very difficult to achieve.  To develop this skill, most OB/GYN and General Surgery physicians must undergo fellowship training in laparoscopy after completing an OB/GYN or General Surgery residency.

Da Vinci Endo WristDa Vinci Surgery is an advanced type of Laparoscopic surgery.  The da Vinci laparoscope contains two separate cameras.  The two images are superimposed at the surgeon’s operative terminal, which creates a binocular image, and provides true 3-D visualization of the operative field.  The robotic arm holds the laparoscope which allows the surgeon direct control of the surgical image (instead of having to rely on the surgical assistant).  The surgical instruments are controlled by the surgeon at the distil tip, and have the same free range of motion as the surgeon’s wrist.  This Endowrist allows for surgeons to perform surgery laparoscopically with the exact same ease and precision as though their hands were actually inside the abdomen.  

These technological advances offer all of the following advantages over laparoscopic surgery:

  • Better visualization
  • Better instrumentation allowing for more precise surgical dissection
  • Better surgical dexterity simplifying complex surgical procedures
  • Easier and faster suturing
  • Surgeon’s control of the robotic arms allows for less dependence on the surgical assistant
  • Permits general GYN surgeons to perform basic GYN surgery laparoscopically—without extensive advanced training
  • Allows specialists to perform difficult cases laparoscopically
  • Better ergonomics allows for decreased surgeon fatigue

What types of surgical procedures can be done with the da Vinci Robot?

  • Hysterectomy
  • Removal of Fibroid tumors (Myomectomy)
  • Removal of Ovarian cysts, ovarian tumors
  • Infertility surgery (tubal reanastamosis and correction of abnormal tube)
  • Endometriosis surgery
  • Prolapse surgery—suspension of fallen vaginal apex (Sacral-colpopexy) (Pelvic prolapse)
  • Pelvic Pain Surgery (Presacral Neurectomy)

What questions should I ask my doctor about Robotic Surgery?

Keep in mind that conventional laparotomy, laparoscopy, and da Vinci surgery all fall within the standard of care, and each have their own advantages and disadvantages.  Your physician should be able to explain these details to your satisfaction. Every surgery, and every patient is different, and you should discuss each of these surgical options with your physician.

When you have a condition which requires surgery, it can be a very difficult and frightening time in your life.  You must feel completely contented with, and confident in your physician.  If you are comfortable with your doctor, than any of the above options should be satisfactory.  However if your physician is uncomfortable with or irritated by discussing these options you should seek a second opinion. Minimally invasive surgery is an option for virtually every woman. If you’ve been told you are not a candidate for robotic surgery, contact us for an evaluation.

You should ask your physician the following questions:

  • What type of surgery do you think is best for me and why?
  • How many laparoscopic or Robotic procedures have you done?
    (Studies show that surgical proficiency starts at  20 to 90 procedures)
  • What is your Conversion Rate (the chances that my robotic surgery will turn into an open incision to complete the surgery)?  Dr. Farnam’s Conversion Rate is less than 1 in 400.
  • Are you board certified?

How many laparoscopic or Robotic procedures have you done?

The learning curve for robotic surgery is between 20-90 cases.  Intuitive Surgical, the makers of the da Vinci surgical robot, considers a robotic surgeon a true expert after completing 200 cases.

Dr. Farnam Robotic Hysterectomy Complication Rate

*Garry R. et al. The eVALuate study: two parallel randomised trails, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 2004; 328:129
**Texas Institute for Robotic Surgery surgical database 2011-2013.  Data on file

Dr. Farnam Robotic Hysterectomies vs Average

* Magrina. J. Separating the O from the G. AAGL 42nd Global Congress
**Intuitive surgical El Paso data 2013. Data on file

Is the robotic surgery covered by my insurance?

Yes. If your insurance carrier approves the surgery, it can be performed by laparotomy, laparoscopy, or da Vinci.  If surgery is indicated, we will contact your insurance company to verify benefits and policy coverage.

Where do we have a da Vinci Surgical System in El Paso?

There are da Vinci Robots at almost every major hospital in El Paso.  The Texas Institute for Robotic Surgery at Las Palmas Medical Center has three Si Robotic systems, and a teaching Dual Console system. It is the only Epicenter in the southwest.  

For more information regarding the da Vinci surgical system please visit the Intuitive Surgical website: www.davincisurgery.com

Robotic Single Site Surgery - Susan's Story


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