Robotic surgery

Gynaecology and obstetrics is a highly comprehensive specialty that encompasses pregnancy monitoring, infertility treatment, childbirth, annual check-ups including cervical smear tests, pelvic ultrasound for pelvic organs, and, if necessary, surgical interventions

Drs. Maene and Bafort accompany you with their extensive experience in various subspecialties

Surgical techniques have evolved significantly in recent years. In the past, a hysterectomy (the operation to remove the uterus) required a large abdominal incision. As a result, the patient had to stay in the hospital for a period ranging from one week to 14 days. Later, we opted for an incision in the bikini line region (Pfannenstiel incision or cesarean scar), which is aesthetically preferable for the patient. With the adoption of laparoscopic surgery, the incisions have become smaller, and the patient’s hospital stay duration has significantly decreased.

Robotic surgery

Robotic surgery

Minimally invasive surgical procedure

Minimally invasive interventions are often performed using a robot. When the robot is connected to traditional laparoscopic ports in the abdomen, the patient’s tissues undergo less trauma, leading to reduced postoperative pain. Additionally, the robot is equipped with a camera that offers a 10 times magnification and optical zoom function, along with 360-degree mobility, facilitating the surgery’s execution. The robot also allows us to switch to FireFly mode and mark lymph nodes in fluorescent green. Robotic operations are performed in the following cases:

  • Hysterectomy: Removal of the uterus (often combined with fallopian tube removal in pre-menopausal patients or ovarian removal in post-menopausal patients).
  • Myomectomy: Removal of uterine fibroids.
    Unilateral Pectineal Suspension (UPS): Repair of pelvic muscles.
  • Hysterectomy with sentinel node biopsy in cases of endometrial cancer.
  • Endometriosis surgery.
Video Da Vinci

Hysterectomie

Video Da Vinci

Tuba Reanastomosis

Video Da Vinci

UPS

Video Da Vinci

DIE RV Nodule

Procedures

Cystectomy - Removal of Ovarian Cysts

Cystectomy is a surgical procedure consisting of the removal of ovarian cysts. This operation can be performed, for example, in young women with an ovarian dermoid cyst. The goal of cystectomy is to preserve ovarian function as much as possible and minimize risks to the patient’s health.

Hysterectomy - Removal of the uterus.

We now also perform robotic-assisted hysterectomies. Hysterectomy involves the removal of the uterus due to issues such as excessive bleeding, pain, or malignant disease. With this approach, we’ve observed significantly faster recovery compared to traditional surgical laparoscopy, and in over 90% of cases, patients are discharged from the hospital the day after surgery.
In case of malignancy (uterine cancer or endometrial cancer), the robotic procedure can also be utilized to locate and remove sentinel lymph nodes, enabling the examination of more tissue and potential spread to lymphatic vessels.

Sterilization reversal or tubal reanastomosis.

If a traditional tubal ligation has been performed in patients (division of the tubes as a method of contraception) and when the tubal ends are sufficiently long, it is possible to reconnect these ends (tubal reanastomosis) with a robotic approach.

DA VINCI Myomectomy - Removal of Uterine Fibroids.

We now also perform myomectomies through robotic surgery. Myomectomy involves the removal of uterine fibroids, which are benign tumors that develop in the muscles of the uterus and can sometimes cause bothersome symptoms depending on their location and size. Women with uterine fibroids may experience heavy bleeding during periods, possibly accompanied by intense pain, and may also feel pressure in the lower abdomen and discomfort or pain during sexual intercourse. These symptoms can be a reason to undergo fibroid removal surgery, keeping the rest of the uterus, and thus the capacity for pregnancy, in place.

Recently, we have been performing uterine fibroid removals robotically, speeding up recovery and reducing postoperative pain, while also performing the procedure with greater precision and efficiency. This surgery is performed through four small 7mm incisions in the abdomen. To reduce blood loss during the operation, we first identify the main feeding artery (uterine artery) that supplies blood to the uterus. Clamps are placed on either side of this artery to temporarily obstruct the uterine blood supply. This allows us to perform fibroid removal with minimal blood loss. After fibroid removal is complete, the uterus is closed, and the clamps are removed, restoring blood supply. The fibroid is placed in a bag to facilitate its extraction through one of the incisions, which is slightly enlarged.

This surgery can typically be done as a day case procedure. Recovery after surgery is faster than with the traditional approach, allowing individuals to return to work sooner. The period of work incapacity usually lasts around three weeks, but often patients can resume their daily activities after just one week.

DA VINCI UPS

UPS is a surgery that enables us to strengthen the pelvic floor (Unilateral Pectineal Suspension – UPS) using the robotic platform. This operation is the first step in restoring pelvic floor function. Weakened pelvic muscles can manifest in various forms, such as bladder prolapse, uterine prolapse, stress incontinence (loss of bladder control during coughing/laughing/sneezing), urge incontinence (loss of bladder control when the bladder is full), vaginal bulging sensation, and pain during intercourse.

In the past, the common approach to treating prolapse involved vaginal hysterectomy and suture fixation of the bladder. In some cases, a mesh prosthesis, inserted transabdominally, was required. These surgeries often involve a hysterectomy, and an extended hospital stay with the possibility of postoperative micturition problems. Furthermore, pelvic floor function remains compromised after this operation, meaning a recurrence can sometimes be observed after a few years.

Thanks to this new robotic technique, we preserve the uterus and reposition it in its natural location, often improving bladder and/or bowel prolapse. We fix the cervix in a tension-free manner to the ligaments of the pelvic bone (pectineal ligament). This helps maintain the functions of the uterus and vagina, as well as their mobility. The operation takes but 15 minutes once the Da Vinci robot is docked, and the patient experiences minimal postoperative pain.
Postoperative recovery is rapid, and most patients can resume their daily activities after one week. The period of work incapacity is usually around two weeks.

DA VINCI Endometriosis Excision

Endometriosis is a common condition characterized by the presence of endometrial tissue outside the uterine cavity, particularly in sites such as the bladder, intestines, adipose tissue, and ovaries. This leads to chronic inflammatory reactions, with intense pain as the primary symptom, especially during menstruation. Bleeding occurs not only within the uterus but also in these ectopic implantation sites.

The typical endometriosis patient presents with persistent acute pain during menstruation that does not subside despite treatment with oral contraceptives or an intrauterine device. These women often visit their doctor frequently, but the cause of their pain is not immediately identified. Ultrasounds and sometimes MRIs often show normal results. The average delay in diagnosing endometriosis is 7 to 10 years.

There are two types of endometriosis: superficial and deep. Deep endometriosis lesions (nodules) are relatively easy to detect in imaging (ultrasound or MRI). However, superficial endometriosis lesions on the peritoneum can be very small and therefore may not be detected by imaging.

For the past three years, Drs. Maene and Bafort have attended the EndoDubai conference in Dubai, where Professor Arnaud Wattiez from Strasbourg invites global experts in endometriosis surgery to give lectures.

In young women experiencing recurring pain (sometimes requiring daily analgesics) and progressively worsening menstruation without radiological anomalies, an exploratory laparoscopy is indicated Superficial endometriosis lesions on the peritoneum need to be identified during this diagnostic laparoscopy. Surgical intervention can then be considered to precisely remove them using robotics.
Recovery after robotic removal of these lesions is generally rapid compared to traditional techniques. The recovery period after surgery is generally around two weeks.

DA VINCI Total Hysterectomy with Sentinel Node Biopsy in Endometrial Cancer.

Endometrial cancer is the second most common type of gynaecological cancer worldwide. This type of cancer is often observed after menopause due to increased exposure to the female hormone estrogen. Overweight patients produce more estrogen in their adipose tissues, making endometrial cancer more prevalent among them.

The treatment for this type of cancer involves the removal of the uterus and ovaries. Additionally, the first adjacent lymph node chain

Endometrial cancer is the second most common type of gynaecological cancer worldwide. This type of cancer is often observed after menopause due to increased exposure to the female hormone estrogen. Overweight patients produce more estrogen in their adipose tissues, making endometrial cancer more prevalent among them.

The treatment for this type of cancer involves the removal of the uterus and ovaries. Additionally, the first adjacent lymph node chain to the uterus is examined: the sentinel lymph node. By injecting a blue dye into the cervix at the beginning of the operation, we can visualize the sentinel node in Firefly mode, which colors the lymph node chain in fluorescent green. This way, we can precisely remove this sentinel node without the need to take out all regional nodes. This results in significantly reduced postoperative issues: patients recover faster and experience less lymphatic fluid buildup in the legs (lymphocele).

Thanks to robotic surgery, we can easily locate and precisely remove the sentinel lymph node.

to the uterus is examined: the sentinel lymph node. By injecting a blue dye into the cervix at the beginning of the operation, we can visualize the sentinel node in Firefly mode, which colors the lymph node chain in fluorescent green. This way, we can precisely remove this sentinel node without the need to take out all regional nodes. This results in significantly reduced postoperative issues: patients recover faster and experience less lymphatic fluid buildup in the legs (lymphocele).

Thanks to robotic surgery, we can easily locate and precisely remove the sentinel lymph node.