By Brenda Bouser

Once used exclusively for prostate surgeries at FirstHealth Moore Regional Hospital, robot technology is now being used for certain gynecological procedures.

The da Vinci Robotic Surgical System allows gynecologists to perform some complex hysterectomies, as well as uterine fibroid removal and pelvic support reconstruction, as minimally invasive procedures. Because the operations are done through a few tiny incisions instead of one large one, patients typically have less pain, shorter hospital stays and much faster recovery.

With robot-assisted procedures, the surgeon sits at a console a few feet from the patient and guides the movement of surgical instruments at the end of the robot’s arms. Two cameras mounted on a scope, which is inserted through a small incision, transmit threedimensional video images of the surgical field to a monitor in front of the console, giving the surgeon a remarkably clear view.

“The visualization is unprecedented,” says Walter Fasolak, D.O., an obstetrician and gynecologist with Southern Pines Women’s Health Center. “The two cameras at the tip of the scope are within an inch or two of what you’re operating on, so you’ve got a beautiful view that fills the screen.” Stephen Szabo, M.D., an OB/GYN specialist with Pinehurst Surgical’s Women’s Care Center, says the robotic system allows him to maneuver surgical instruments more precisely than is possible with conventional laparoscopic surgery.

“When you are sitting at the console and controlling the instrument, it’s almost like the instrument is in the palm of your hand,” he says. “It’s much like the feeling of openincision surgery. Suturing is more precise, and dissecting tissue to identify veins and arteries is easier and more controlled. The system is designed to be like an extension of your body, so you think it and it happens.”

Because of the availability of robot technology, surgeons can now offer more patients the benefits of minimally invasive surgery. “I can do more difficult, complex cases on patients who otherwise wouldn’t be able to have laparoscopic surgery,” Dr. Szabo says.

“The robot allows me to take a big, conventional open surgery and turn it into a surgery where the patient is going to go home the same day or the next day and will be pretty much back to normal in a week rather than a month.”

Dr. Fasolak describes the robotic system as a major advance in gynecologic surgery. “There is tremendous satisfaction in being able to offer it to patients, because they are certainly going to benefit from it,” he says.

Two patients, two surgeries, one robot

Kathy has vivid memories of the traditional hysterectomy she had back in the early 1990s—especially the large incision, the pain and the wrenching nausea caused by her pain medication.

Because those memories stayed with her, she had an unusual question for her gynecologist when it became apparent that she would need extensive pelvic reconstruction surgery. “Will you be using the robot?” she asked.

As she recalls, the rest of the conversation went something like this: “He said, ‘Yes,’ and I said, ‘Cool.’”

Walter Fasolak, D.O.

Stephen Szabo, M.D.

Kathy, who did not want her last name used for this story, had her surgery on Jan. 9, 2009, joining an increasing number of women in the mid- Carolinas who have chosen robotic surgery for their gynecologic procedures. Both Walter Fasolak, D.O., of Southern Pines Women’s Health Center, (who was Kathy’s surgeon), and Stephen Szabo, M.D., of Pinehurst Surgical’s Women’s Care Center, are certified to use the da Vinci Robotic Surgery System at FirstHealth Moore Regional Hospital.

Shelley Burge also had a good experience with her da Vinci surgery, a total laparoscopic hysterectomy to deal with heavy bleeding caused by tissue build-up on the wall of her uterus. Although not previously familiar with robot-assisted surgery, she was comfortable about having the procedure after Dr. Szabo explained it and its advantages to her.

“My doctor was still in control of the robot,” Burge says. “He was at the helm. I had that trust and relationship with Dr. Szabo. I absolutely trusted him.”

The prospect of a speedier recovery and earlier hospital discharge was especially important to the 34-year-old Burge, a military wife about to move with her husband and two young children from Fort Bragg to Fort Gordon, Ga. She had her surgery on Dec. 30, 2008, and the family left for Georgia on Jan. 23, 2009. She says she did a lot of the packing, and even some lifting, without any problems at all.

“I’m fine,” says Burge. “I didn’t have any trouble at all, just a little bleeding that was just the sutures healing, but nothing to worry about. I’ve really been fine.”

According to both surgeons, some women have doubts about entrusting their surgery to robot technology, but Kathy, like Shelley Burge, had absolutely no reservations.

“Some people are hesitant to do it,” she says.

“They think it’s too far out, but I’m very openminded about that kind of thing, and I trusted Dr. Fasolak.”

For more information on robot-assisted surgery at FirstHealth Moore Regional Hospital, call (800) 213-3284.