Robotic Surgery in NYC | Dr. C.Y. Liu

The da Vinci Robotic Surgical System has been the only commercially available surgical robot for the past 10 years, and its manufacturer has launched an unusually successful marketing campaign. Their goal is to make the public to believe that robotic surgery is superior to all surgery including laparoscopic surgery, and that the surgeon who performs robotic surgery is the best surgeon with the best surgical outcomes. Unfortunately, this marketing ploy is totally unsubstantiated in research reports appearing in peer reviewed medical journals!

A robot is merely a surgical tool, like lasers, staplers, or electrosurgical instruments, to help the surgeon to achieve his/her surgical goals.  Just like C0-2 laser, a robot is a good but expensive surgical tool, costing 2.1 million for the SI model. Never will there be a perfect surgical instrument on the market devoid of any disadvantages. The biggest advantage of the robot is that it provides the surgeon a three dimensional and magnified view of the operative field that enables the surgeon to see more clearly. The greatest disadvantage is that the surgeon loses the all-important tactile sensation of the tissue or organ being operated on, because he/she is sitting at the console and not by the patient during robotic surgery. For routine surgery, benign or malignant, where there is minimal adhesions or distortion of the anatomy, such as a routine hysterectomy, myomectomy (removal of fibroids), or ovarian surgery, robotic surgery is an excellent choice.  However, if there are dense adhesions, severe endometriosis, difficult hysterectomy/ myomectomy, or pelvic organ prolapse, the anatomy of the pelvis becomes distorted which makes it difficult to tell by vision alone, the difference between normal and abnormal tissue. In such cases, the surgeon’s tactile feeling of tissues or organs during surgery becomes extremely important in order to avoid surgical complication and to attain the best surgical outcomes.

With the modern video camera which magnifies the operative field onto high resolution, high definition monitors in traditional laparoscopic surgery, the 3 D visibility of robotic surgery only holds very minimal advantage over the traditional laparoscopic surgery.

The most crucial factor for successful surgery is the operating surgeon. His knowledge of anatomy and pathology, his surgical proficiency, competence, and skill can never be replaced by a robot. The most expensive tool is only as good as the hand that holds it. An incompetent surgeon with the best instrument cannot produce a successful surgery.

Frequently asked questions:

What are the advantages and disadvantages of robotic surgery in gynecology?

Answer: The robot provides the operating surgeon a clear 3-D magnified view of the operative field, enabling the surgeon to have a better view of the operative field, thus doing a better job with better surgical outcomes. Another advantage of robot is that the surgeon sits in the console and thereby is less fatigued during a lengthy surgery.  However, with the modern laparoscopic video camera and high resolution, high definition monitors used in the traditional laparoscopic surgery, the advantage of better visualization afforded by the robot is becoming very narrow now.

The greatest disadvantage of robotic surgery is that the surgeon lose the tactile sensation of operating tissues and organs during the surgery.  Because the surgeon is sitting in the console, away from the patient, he/she does not have the tactile feeling of the operating tissues.  This lost of the tactile sensation can be very important in patients having  complicated pathology, dense adhesions, distorted anatomy, or female organ prolapses.

The other disadvantage of robotic surgery is cost. The cost of the da Vinci Robotic Surgical System (SI) is about $2.1 million, with an additional annual maintenance fee of $210,000. This creates a financial burden both for hospital and health care system of the country and, ultimately, the patient.

Isn’t robotic surgery a part of laparoscopic surgery?

Answer: Yes, robotic surgery is part of laparoscopic surgery even though the robotic company would like to make the public think otherwise. In robotic surgery, two video cameras are used to produce 3-D views, and the cameras are about twice the size of that used in traditional laparoscopy. To accommodate the larger camera and larger robotic instruments, the surgeon must make larger incisions. 

Are there any differences between robotic surgery and traditional laparoscopic surgery in terms of pain, discomfort, and recovery time?

Answer: Incisions for robotic surgery are larger than those in traditional laparoscopic surgery, but there is no difference in terms of postoperative pain, discomfort, and recovery time.

How do I know I will benefit from robotic surgery?

Answer: As mentioned earlier, if your condition is not complicated and is considered a straightforward hysterectomy, myomectomy, or ovarian surgery, a robotic surgery will benefit you and probably your surgeon if he/she is not very proficient in traditional operative laparoscopy. However, if you have more complicated pathology with more distorted anatomy such as severe endometriosis, dense adhesion, difficult hysterectomy/myomectomy, large ovarian cyst, pelvic organ prolapses, a traditional laparoscopic surgery by a competent, experienced, and proficient laparoscopic surgeon will give you the best surgical outcomes. 

Dr. Liu is a pioneer in laparoscopic surgery, having developed a number of laparoscopic surgical techniques. For the past 25 years, his practice has been limited to laparoscopic surgery. As a well-trained and experienced robotic surgeon, he is in the best position to provide you a balanced and honest opinion about the type of surgery that will benefit you the most.

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