Originally published in HealthScene Ohio in 2018
The move toward minimally invasive surgery has been noticeable across a vast array of medical fields.
Obstetrician and gynecologist Dr. Lorie Thomas of Blanchard Valley Health System has worked alongside colleagues to develop robot-assisted surgeries that help surgeons reduce patients’ time in surgery, lessen pain and shorten recovery time after procedures are done.
HealthScene Ohio: What have been some of the new developments within the field of robotic gynecologic surgery?
Dr. Lorie Thomas: The benefits of the robotic platform, such as improvement in visualization and precision, allow complex surgeries in gynecology to be done in a minimally invasive fashion, such as resection of endometriosis, large uterine fibroids, sacro-colpopexy and retropubic urethropexy. Improvements in the robotic platform have allowed surgery to be done in more than one area of the abdomen without having to move large equipment or the patient.
New instruments are being developed on a regular basis to meet the needs of the procedures and surgeons performing them. The improvements are assisting surgeons in ways that shorten the length of surgery by making the procedures easier to accomplish.
HSO: What impact do these new developments have on patients undergoing these surgeries?
LT: The ability to perform these robotic and minimally invasive surgeries will allow a patient to go home the same day or simply require an overnight stay. These patients would otherwise have a two-to-four-day hospital stay. Robotic surgery typically reduces post-operative pain because smaller incisions are made which requires less narcotic pain medications. The use of fewer narcotics helps to prevent severe constipation, reducing pain.
Robotic surgery also facilitates a rapid return to work, such as one week after a hysterectomy rather than six weeks, which helps the individual as well as the company he or she works for. A minimally invasive procedure also has less blood loss, which, in turn, reduces the need for blood transfusions and the side effects and complications related to transfusion.
HSO: How does robotic surgery make gynecological surgeries less invasive?
LT: The incisions are dime-sized, compared to completely open from the umbilicus to the pelvic bone or from one side of the pelvis to the other.
HSO: How does the approach to performing surgery in the field of gynecology differ from the approach to surgery in other fields? Is there a difference?
LT: Gynecologic surgery focuses on one specific area, the pelvis, unlike general surgery that may require movement throughout the abdomen. The newest version of the robotic platform called the da Vinci Xi addresses this and allows the surgeon to be able to move the camera or instruments into any port for better visualization or function.
Each specialty has instrumentation that may be more individualized for needs during a procedure. These instruments are all able to be used by the Xi platform. Intuitive Surgical is continuously working with its biomedical engineers to develop new instruments to meet the needs of the procedures being performed.
HSO: Is it particularly important to have surgery be as non-invasive as possible in the field of gynecological surgery? Why or why not?
LT: It is for appropriate cases. Less blood loss, quicker return to work, fewer complications, less pain and smaller scars are benefits in less invasive surgical procedures.
HSO: What did gynecologic surgery look like before robotic surgery?
LT: Gynecologic surgery involved large incisions and, many times, significant blood loss. The patient would recover over two to four days in the hospital and would return home dealing with significant pain, requiring narcotic pain meds for several weeks, leaving them unable to perform their routine home activities without assistance or return to work before six to eight weeks. Returning to the operating room for complications, treating infections and receiving blood transfusions were more commonly seen.
HSO: How has robotic surgery improved the field of gynecological surgery?
LT: Robotic surgery has allowed me to take all of the laparoscopic procedures I could not accomplish leading to an open incision and make them all minimally invasive. This is a win for everyone involved but, most importantly, for the patient.
HSO: How do you see the field of gynecological surgery and robotic surgery evolving from here?
LT: I see many other specialties eventually having robotic applications, giving each surgeon and specialist the benefits seen in urologic, gynecologic, general surgery, ENT and vascular surgery. I look forward to one day being able to have robotic applications in vaginal surgery, which is limited by poor visualization.
HSO: Are there ways to do minimally invasive surgeries without robotic surgery?
LT: Many of the surgeries can be performed by standard laparoscopy, but are much more difficult. Robotic surgery has been able to give the gynecologic surgeon who was limited in his or her abilities to perform laparoscopic surgery, due to its difficulty, the confidence and skill needed. More surgeons able to perform the needed surgeries in a minimally invasive manner allows more patients the opportunity to have their procedures with all the above-listed benefits.
Before 2010, I would perform approximately 60 percent of my surgeries minimally invasive, and after 2010, all viable surgeries have been accomplished with the da Vinci robotic platform.
HSO: How has the development of robotic surgery changed the surgical field in general?
LT: The surgical field in the past involved a large open incision with a patient placed on a table and several people around retracting and assisting with visualization. The surgical field of today involves a patient on a table with several small ports placed through tiny incisions the size of a dime. These ports allow instruments to be switched by an assistant while the surgeon sits at a console next to the patient, performing the surgery while viewing the inside of the patient’s abdomen through magnified 3-D visualization.
Emily Real is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Dr. Lorie Thomas is a graduate of Jacksonville University in Jacksonville, Florida. She received her Doctor of Osteopathy degree from the Ohio University College of Osteopathic Medicine in Athens and completed her residency in obstetrics and gynecology at St. Vincent Mercy Medical Center in Toledo. She is certified by the American Board of Osteopathic Obstetrics and Gynecology. Dr. Thomas has been practicing in the Findlay area for more than 15 years.
Dr. Thomas’s clinical focus includes all aspects of gynecology, with a particular interest in minimally invasive surgery, including robotic surgery. She is the chairperson of robotic surgery at Blanchard Valley Hospital.
