August 20, 2019
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Bangor hospital touts robotic hysterectomy procedure

BANGOR, Maine — Eastern Maine Medical Center will reach a “surgical milestone” on Wednesday by performing the state’s first single-incision hysterectomy with the help of a robot.

Dr. Pamela Gilmore will perform the procedure using the hospital’s da Vinci robotic surgery system, removing the patient’s uterus through one tiny incision in the navel.

Along with EMMC, MaineGeneral hospital in Augusta and Maine Medical Center in Portland also perform robotic hysterectomies. EMMC is the first hospital in Maine to perform the procedure robotically with just a single incision, Gilmore said.

“We’re introducing a new dimension to gynecologic surgery,” she said Tuesday during a demonstration of the robotic system at the hospital.

With robotic procedures, a surgeon manipulates tiny surgical instruments using hand controls at a computer system situated a few feet away from the patient. A video camera on one of the arms provides a view inside the patient’s body.

Hysterectomies also can be performed several other ways, such as through a large abdominal incision or through less invasive approaches, including a small opening at the top of the vagina, or laparoscopic surgery, in which the surgeon manipulates instruments and a tiny lighted camera through small incisions in the navel and abdomen.

The da Vinci robot has been promoted heavily by many hospitals nationally as a cutting-edge surgical technology. The system, with a price tag of more than $1 million, has come under greater scrutiny as its use has skyrocketed.

The FDA is investigating a spike in the number of problems reported with robotic surgeries. In December, EMMC robotic surgeon Dr. Michelle Toder said some of the reports were old or involved incidents that weren’t the fault of the robotic technology.

In March 2013, a leading obstetrician-gynecologists group questioned the use of surgical robots for routine hysterectomies, citing a study that found robots led to no better results than other procedures but cost much more.

“There is no good data proving that robotic hysterectomy is even as good as — let alone better — than existing, and far less costly, minimally invasive alternatives,” James Breeden, president of the American Congress of Obstetricians and Gynecologists said in the March statement.

Gilmore said single-incision robotic hysterectomies lead to less blood loss, minimal scarring and faster recovery times.

“I think women are going to heal quicker from this. I think they’re going to be satisfied with the tiny little incision,” Gilmore said. “It’s just going to offer women the option of doing something different.”

At EMMC, the single-incision approach is reserved for uncomplicated cases and may also involve removal of the ovaries, she said. Women with fibroids or larger wombs may need multiple incisions or other approaches, she said.

“Patient selection is very important,” as is a surgeon’s training, said Gilmore, the only surgeon at EMMC qualified to perform single-incision robotic hysterectomies.

EMMC patients have healed well from robotic-assisted hysterectomies, she said. While injuries are possible, laparoscopic surgeries carry the same risk, Gilmore said.

The use of robots for hysterectomies, one of the most common surgical procedures, jumped from less than 0.5 percent to nearly 10 percent over the past three years, according to a study in the Journal of the American Medical Association.

The JAMA study, which examined more than 260,000 hysterectomy patients, found that “robotics added an average of $2,000 per procedure without any demonstrable benefit,” ACOG said in its March statement. The study also found that while patients with robotic hysterectomies were less likely than laparoscopic patients to be hospitalized for more than two days, the two groups showed no difference on other indicators such as complications.


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