Expert Commentary: Tapan A. Mehta, M.D. - 11/05/2009
Laparoscopic techniques for benign gynecologic surgery has been used for many years. But the straight, rigid instruments that were used limited what could be accomplished, surgically. Thus a laparoscopic approach for complicated gynecologic surgery, while available, has been accessible to only a limited number of people because few gynecologic surgeons have the experience to perform such surgeries.
I have been performing traditional laparoscopic surgeries for hysterectomies, myomectomies, treatment for endometriosis as well as for ectopic pregnancies for many years. However, I only could perform these laparoscopic techniques on individuals that did not have a history of any prior abdominal surgery due to the limitations of the surgical instruments. These women have a higher chance of having developed adhesions (scar tissue) that can distort the normal relationship of the pelvic organs and obscure tissue plans that would make the surgery more complicated.
With the development of the Davinci Surgerical Platform, I am now able to perform a Davinci assisted laparoscopic hysterectomy for a patient with previous abdominal surgeries. The Davinci Platform gives a higher magnification and better visualization - with a better definition verses the traditional laparoscopic camera. This allows us to perform surgery at a very close range and with better results. The Davinci Platform also allows me to control the surgical instruments with a higher degree of precision because of the wrist like joint that is built into the surgical instrument that actually behaves like a human wrist joint. This is important because this joint in the instrument is actually located in the patient and allows the instrument to behave as if my fingers were actually inside the patient like an open abdominal surgery.
The advantage is that we can perform a hysterectomy or myomectomy or any other complex pelvic surgery with these minimally invasive techniques, using only 3 or 4 small. Many gynecologists still perform the same procedures as open abdominal surgery. The newer robotic laparoscopic techniques lead to a significantly decreased amount of post-operative pain, shorter recovery time and in most cases no overnight hospital stay. Most of my patients go home on the same day.
Dr Tapan Mehta
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