Sydney Adventist Hospital Surgeons Perform Complex Robotic Surgery

In a first for Sydney Adventist Hospital, a complex dual-console gynecological operation using the state-of-the-art da Vinci robot has been performed with the surgeons working side by side simultaneously.

Sydney Adventist Hospital, known as the San, is currently one of only four hospitals in New South Wales, Australia, to have dual consoles for surgery. The procedure involves both surgeons controlling the highly advanced robotic technology while seated at separate consoles, sharing and swapping control of the instruments, taking turns as needed to complete the combined gynecological-colorectal procedure. The patient required both a hysterectomy and surgery to remove severe endometriosis that extended into the bowel.

Endometriosis is a condition in which the tissue that lines the inside of the uterus grows outside the uterus on other organs and structures in the body. It can progressively worsen, causing pelvic and period pain, pain during sexual intercourse, and infertility.

The San is home to best-in-the-world robotic equipment following the October 2017 installation of the AUS $3 million da Vinci Xi robot surgical system, which complements the San’s existing da Vinci X robot, making it Australia’s first private hospital to have both the X and the Xi models.

The use of the dual consoles at the San builds on the benefits of the da Vinci robot, including small, minimally invasive incisions, resulting in quicker, less painful recovery with less blood loss, and also providing surgeons with high-definition 3D imaging, greater dexterity, and more stability.

Stephen Pillinger, director of robotic colorectal surgery at the San, who performed the first operation last October with the Xi, said the dual console allows a multidisciplinary approach from start to finish. From the first consultation through multidisciplinary operative planning to dual-console surgery, everyone caring for the patient is actively involved.

“Approaching the treatment of endometriosis by having various surgeons consult in advance, review dedicated imaging in a multidisciplinary setting, [and] understand what they are likely to face during the operation makes it a very coordinated, planned approach,” he said. “It produces better surgical precision and outcomes for patients.”

Gynecological surgeon Yogesh Nikam, who operated with Pillinger, agrees. “This is a logical progression of robotics,” he said.

“It is using this technology to allow a multidisciplinary approach between surgeons to treat endometriosis. It means an appropriate and complete procedure can be done for a patient, reducing the possibility of recurrence and the need for another surgery.”

The patient for this dual-console procedure was a 48-year-old woman who had suffered from debilitating endometriosis for several years.

“This was a complex condition requiring highly advanced surgery,” Nikam said.

“Traditional surgery would have meant the patient had a large wound, might have spent five to seven days in the hospital, and could have been recovering for up to twelve weeks. Using the robotic platform provides an edge over its laparoscopic counterpart with improved visualization of the disease and surgical planes and equates to an improved outcome and decreased surgical pain for the patient.

“Because we were able to do this procedure simultaneously using the robot, the patient is now symptom-free,with minimal chance that further surgery will be needed, was discharged within two days with minimal pain and blood loss, and can expect recovery to take around one to two weeks.

“As a surgeon who has done over a thousand laparoscopic hysterectomies, I’m thrilled seeing how well patients recover after the procedure using the robot.”

Pillinger said the reduced costs to patients of robotic procedures, thanks to a decision by the San to absorb the cost of the consumables used, is further boosted by procedures like this, which use the dual consoles.

“Patients can be better informed about the planned surgery, there’s much better use of resources regarding theatre and the surgeon’s time, and it’s a very streamlined, more co-ordinated approach.

“This is personalized, coordinated treatment at its best,” he said.