As recently as a generation ago, the commonplace surgery known as a hysterectomy—averaging some 700,000 procedures a year in the U.S. alone-- was a major ordeal for both surgeons and patients, requiring a hospital stay of up to a week, a recovery time of six weeks or more, and leaving a permanent abdominal scar.
The recent advent of robotic surgery has made removing the uterus far less invasive than the traditional method. But now, a Huntsville physician has taken robot-assisted surgery a step further by performing the first single-site hysterectomy in the state.
"The overall trend in surgery is toward minimally invasive," says Michael Conrad, MD, of Crestwood Medical Center, "and while neither robotic or single-incision surgery is new, combining the two requires special equipment and additional training in using it." But the benefits are numerous, ranging from less risk of complications to reduced recovery times.
While typical robotic surgeries require between three and five small incisions, the new single-site hysterectomy procedure is performed through a single incision in the patient's belly button, according to Susan Bryce, Crestwood's assistant chief nursing officer. "Anytime you're cutting through muscle, it adds to the necessary recovery time," Bryce says, "and there's also a greater chance of infection, especially when a fat pad is involved. So this new technique means a reduced chance of infection, and virtually no scarring as opposed to when the incision is made through muscle."
The single-site surgery is performed under general anesthesia, and typically requires about an hour. Other advantages include a hospital stay of 24 hours or less, lowered blood loss, minimal pain post-operatively, and a high degree of patient satisfaction with the results.
The layout of the new-generation surgical suite is different than the traditional arrangement of a physician standing over the patient and surrounded by other members of the team. Instead, the surgeon occupies a high-tech console in front of a high-definition, 3-D video monitor while manipulating hand controls for the miniature instruments that have been inserted through the navel.
"One of the biggest differences is the degree of visualization the system provides for the surgeon," says Bryce. "While people's anatomy obviously has a great deal in common, there are also fine differences in structures from patient to patient, and the ability to visualize those fine details is just unbelievable, and a dramatic difference from what's called the 'straight stick' laparoscopic approach."
The single-site approach also means new tasks for staff. "The new setup requires them to be somewhat more hands-on than traditional surgical technicians,” Conrad says. “So it's definitely a team effort, and they're instrumental in the success of the operation." He has brought in an expert speaker on the topic, and underwent many hours of training himself at the facilities of Intuitive Surgical, manufacturer of the da Vinci Robotic Surgical System.
An online demonstration video shows the single-site surgical port as a tiny device shaped like a double-ended funnel, with one half extending underneath the skin and the other outside to receive and guide the flexible tube of the endoscope and other accessories. What doesn't show in the illustration is a sophisticated software system that detects the position of the user's hands and continually re-associates them with the instrument tips of the flexible devices.
This new generation of robotic and laparoscopic surgeries "has required some adjustment in getting used to," according to Conrad. "It's more involved than just having a good command of anatomy. Compared to earlier approaches, it's been the equivalent of moving from Windows 98 to an iPad 3."
The new technology has applications for a wide range of areas other than gynecology. Surgeons at Crestwood Medical Center use the robotic system for urology, otolaryngology, and general surgery, in addition to traditional laparoscopic procedures.
Conrad, a native of Kingsport, Tennessee, attended the University of Tennessee College of Medicine and served a residency at St. John's Mercy Medical Center in St. Louis. He was drawn to surgery from among other possibilities in the field, he says, "because of the chance to have an immediate impact in people's lives."
"The single-site procedure we're offering is the next step in the evolution of surgical technologies," he says. "I'm excited to be the first physician in Alabama to perform this surgery, and to offer our patients a less invasive and better cosmetic option. And we at Crestwood are excited to be a leader today in the surgical treatment of tomorrow."