Less Invasive Gynecologic Surgery - Leads to Quicker Recovery

The addition of robotics has transformed gynecologic surgery at Penn Medicine. Using advanced robotic techniques, Penn offers the most advanced diagnosis and treatment of gynecologic conditions.

An active program with skilled surgeons is the key to successful outcomes in robotic surgery and many of Penn’s gynecologic surgeons are recognized nationally for their experience. In fact, Penn gynecologic surgeons perform more robotic-assisted procedures than any other program in the Philadelphia region.

The primary specialties in which robotic-assisted gynecologic procedures are performed are:

• General gynecology
• Gynecologic oncology
• Adolescent reproductive health
• Reproductive endocrinology and infertility
• Urogynecology and pelvic reconstruction

Penn gynecologic surgeons perform more robotic-assisted procedures than any other program in the Philadelphia area.

Gynecologic Oncology

Gynecologic Oncology Surgery is a primary method of treatment for gynecologic cancers, including cervical, endometrial, ovarian and uterine cancer. Minimally invasive techniques like robotic-assisted surgery have become the standard of care for treating these cancers at Penn.

"We have performed more than 300 robotic gynecologic oncology procedures at Penn," said Thomas Randall, MD, chief of gynecologic oncology at Pennsylvania Hospital. "This is one of the highest volume programs in the country and our ob/gyn residents and fellows receive extensive training in robotic-assisted gynecologic surgery."

Dr. Randall said that over the past few years there has been an 80 percent increase in the number of robotic uterine cancer surgeries being performed at Penn.

"It is a good minimally invasive option for cervical and uterine cancer and we actually see fewer complications in robotic surgery for endometrial cancer than we do in standard laparoscopic procedures," he said.
Dr. Randall said gynecologic surgeons at Penn continue to refine current robotic-assisted techniques and develop better ways to access difficult-to-reach locations. Patients at Penn benefit from the advances developed through ongoing clinical trials.

Urogynecology and Pelvic Reconstruction

Bladder and pelvic floor health issues — including urinary and fecal incontinence, as well as uterine and vaginal prolapse — affect nearly 13 million American women. A growing number of women will be affected by some type of pelvic disorder as the population ages. Urogynecologists at Penn use advanced minimally invasive surgery to treat many women suffering from these disorders.

In some women, the supporting structures of the abdomen can become weakened by hysterectomy, aging, changing hormone levels or vaginal childbirth, causing the vagina to slip down from its normal position.

According to Lily Arya, MD, chief of urogynecology at Penn Medicine, sacrocolpopexy is a procedure in which the vagina is lifted back up to its natural position by attaching a synthetic mesh from the top and back of the vagina to one of the bones at the back of the pelvis (the sacrum). The mesh provides the vagina with the right amount of support to keep it in the correct position.

The procedure can be performed abdominally through an open incision or robotically through tiny incisions in the abdomen.

Both the open and robotic procedures have benefits and disadvantages, according to Dr. Arya. Open abdominal procedures tend to have longer lasting results than robotic and patients usually have better sexual function. However, the recovery is longer and patients have an abdominal scar.

Vaginal prolapse can also be repaired through vaginal incisions. In this case, there is no external scar and the recovery is much quicker than the open abdominal procedure, according to Gina Northington, MD, PhD, urogynecologist at the Hospital of the University of Pennsylvania. Depending on the extent of the surgery, some patients may experience sexual dysfunction.

"Robotic sacrocolpopexy seems to combine all of the benefits of the minimally invasive and open procedures," Dr. Arya said. "Robotic surgery in this area has been available for a little over four years, but so far we are seeing lasting results and quicker recovery without loss of sexual function."

Megan Schimpf, MD, urogynecologist at Pennsylvania Hospital, points out that all patients are different so the best surgical option varies from patient to patient.

"The extent of the surgery needed — combined with the patient’s activity level, previous surgical history, weigh — can determine which procedure may work best," said Dr. Schimpf. "With open, vaginal and robotic procedures available, we can be sure that we provide the patient with the option that is best for her unique case."

Penn Fertility Care is a pioneer in improving tubal anastomosis for women who previously had their fallopian tubes tied or cauterized and wish to restore their fertility.

Reproductive Health and Fertility Care

Penn Fertility Care’s reproductive surgeons are obstetrician/gynecologists specifically trained in the surgical correction related to the anatomical causes of infertility. In the hands of these skilled surgeons, the surgical robot is ideally suited for performing complex procedures in small spaces with optimal results.

Samantha Pfeifer, MD, is currently using a roboticassisted procedure for tubal anastomosis or reversal of tubal ligation. Penn Fertility Care is a pioneer in improving this procedure for women who previously had their fallopian tubes tied or cauterized and, for a variety of reasons, wish to restore their fertility. In select cases, the success rate with this procedure has been excellent.

Dr. Pfeifer also specializes in caring for young women with congenital malformations of the uterus and/or vagina, known as mullerian anomalies. Symptoms usually surface during puberty in the form of abdominal or pelvic pain, or irregular menstrual bleeding. Depending on the extent of the problem, a robotic-assisted procedure can correct the defect.

"Diagnosing and treating a congenital disorder can have a huge impact on a young woman," Dr. Pfeifer said. "A robotic-assisted procedure is less invasive, with a shorter recovery time and minimal scarring — all important considerations for young women — while providing her with the chance to some day start a family."

Patients understand now that the surgeon is still performing the procedure and the robot is just a tool that offers less pain, faster recovery and gets them back to their life.

General Gynecology

The robotics revolution arrived at Penn Ob/Gyn Care in 2007. Currently, robotic-assisted procedures are used to treat abnormal uterine bleeding, uterine fibroids, ovarian cysts, adenomyosis and endometriosis.
Mathew N. Beshara, MD, finds the surgical robot especially beneficial in performing complex and complicated surgeries to treat heavy periods, fibroids and enlarged uterus.

"There are many benefits of robotic-assisted surgery for both the surgeon and the patient," Dr. Beshara said. "Visualization with the surgical robot is excellent and the surgical arms are able to perform complicated maneuvers in a small space. Following a complex robotic-assisted procedure, many women are able to go home the next day."

There are some situations in which robotic-assisted surgery is not appropriate, but it can be used in many of the same procedures that can be done laparoscopically.

Dr. Beshara pointed out that the surgeon is the key to successful robotic-assisted surgery. The tool is only as good — and as experienced — as the surgeon using it. Performing many procedures is crucial to becoming comfortable and proficient with the technology.

Patients have also become more comfortable with the robotic-assisted technology. They understand the benefits and want to get back to their lives as quickly as possible.

"We have really educated our patients about the benefits of robotic-assisted surgery," Dr. Beshara said. "When we first began performing robotic procedures there was a stigma attached to having a 'robot' perform surgery. But patients understand now that the surgeon is still performing the procedure and the robot is just a tool that offers less pain, faster recovery and gets them back to their life. Patients like that."

Excellence in Cancer Care

Penn’s Abramson Cancer Center is known around the world for excellence in diagnosing, preventing and treating cancer. Advances such as proton therapy, robotic-assisted surgery and molecular-targeted therapies, provide Penn with an unprecedented opportunity to tailor the right treatment for every patient.

The Abramson Cancer Center of the University of Pennsylvania, is one of a select group of cancer centers in the country awarded the prestigious designation of Comprehensive Cancer Center by the National Cancer Institute (NCI). This status reflects outstanding research, clinical services, education and information services and community outreach.