Robotic surgery advances provide relief from endometriosis and fibroids ideal gas questions


A: Robotic surgery is an innovative, minimally invasive surgical technique that first became available in the field of gynecology in 2005. Building on the techniques of traditional laparoscopic minimally invasive surgery, the robotic surgical tools are inserted into the patient through ports, which are connected to robotic arms rather than held by the surgeon. These robotic arms are fully operated by the surgeon.

A: The robotic platform can be used to perform a wide array of gynecologic surgeries, including hysterectomy, prolapse surgery, myomectomy (fibroid removal), endometriosis surgery, and gynecologic cancer surgery, among others. For minimally invasive gynecologic surgeons like myself, robotics can be particularly beneficial in endometriosis and fibroid surgery.

A: Endometriosis is a disease in which cells similar to those that line the inside of the uterus (endometrium) grow outside the uterus. The severity of endometriosis can range from mild to severe. It can affect any areas of the abdomen and pelvis, such as the ovary, uterus, bowel, bladder, liver, diaphragm, and abdominal wall.

Symptoms may include pelvic pain, painful periods, painful intercourse, heavy or irregular periods, infertility, gastrointestinal symptoms including constipation, diarrhea, nausea, bloating, painful bowel movements, urinary symptoms including painful urination and urinary frequency and burning, and general fatigue/malaise. Infertility also can be a concern.

A: The robotic platform is a surgical tool that allows a surgeon to operate in 3-D, utilizing wristed instrument motion. With early stage disease, difficulty identifying disease often can be a concern. Three-dimensional visualization and the ability to magnify tissue up to 10-15 times can, therefore, be very beneficial in diagnosis and treatment.

The newer da Vinci robotic Firefly system, through the use of fluorescence imaging, also has the potential to improve the identification of atypical endometriosis lesions during surgery that otherwise may have been missed using standard equipment. In addition, in cases of complex disease, the robotic technique may allow surgeons to operate in areas that otherwise may be difficult to treat.

A: Leiomyoma (or fibroids) are typically benign, noncancerous tumors found in and around the uterus. Women with fibroids may have no symptoms, in which case they rarely necessitate treatment. However, when symptoms occur, they may manifest as heavy or abnormal uterine bleeding, pressure, pain, and/or compression of nearby organs. In some cases, fibroids may cause issues with fertility or pregnancy.

A: Treatment of fibroids can vary significantly based on their symptomatology and a woman’s desire for fertility or pregnancy. Options may include anything from hormones (birth control pills, progesterone intrauterine device or injection), hysteroscopic resection, uterine artery embolization, ablation procedures, fibroid removal, and hysterectomy.

An expert can help you decide the safest, most effective treatment option to meet your unique physical and personal needs. If you and your surgeon ultimately decide surgery is the best option, myomectomy (removal of fibroids) or hysterectomy (removal of uterus with any fibroids) will be discussed.

There are no specific patient criteria to be a candidate for robotic surgery; however, the robotic approach is not right for everyone or every procedure. It is important that you feel comfortable with your surgeon and what procedure they plan to perform. Do not be afraid to get a second opinion if you are having surgery to talk through other surgical options in order to find one that is best for you.

A: While most OB/GYNs are trained in both obstetrics and gynecology, their focus tends to be in obstetrics and basic gynecologic care, rarely performing advanced gynecologic surgeries. Be sure to choose a specialist who has received advanced surgical training and has performed many minimally invasive surgeries to treat endometriosis and fibroids each year.

• Dr. Farah A. Alvi is a board-certified gynecologist with specialized training in endometriosis and fibroid care. She completed her fellowship in minimally invasive gynecologic surgery at Northwestern and joined WomanCare in August 2017. She is trained in robotic surgery and