A recent article<\/a> published in PubMed Central indicates that morbidly obese patients face unique surgical challenges, but robotic surgery for uterine cancer has been found to reduce the incidence of surgical and post-surgical complications.\u00a0<\/p>\nSkolnik says the robot allows surgeons to operate at a lower interabdominal pressure, which is important in surgeries where the patient is tilted backwards to give physicians better access to pelvic organs.<\/p>\n
The positioning, Skolnik says, can create challenges for anesthesiologists who ventilate patients during procedures that increase pressure on the respiratory system.\u00a0<\/p>\n
\u201cWhat\u2019s incredible about the robot is that the visualization is so superior and because our movements are so tiny and precise, we can actually reduce that pressure quite significantly,\u201d she says, adding that the robotic surgery decreases the likelihood of both respiratory and cardiovascular complications.\u00a0<\/p>\n
\u201cA patient with an elevated BMI has a higher risk of having poor ventilation because the pressure from the abdominal wall is so much greater on the chest when you tilt them upside down.\u201d<\/p>\n
Skolnik says that while she and Chan perform laparoscopic procedures whenever possible, open surgeries are also an option when they\u2019ll provide the best outcome for a patient. That said, the robot offers patients who might not have been good candidates for a less invasive surgery another option.<\/p>\n
It also ensures a patient with a higher BMI who lives in Brampton can access surgery close to home, removing some of the stress of travelling out of town for a major operation.\u00a0<\/p>\n
\u201cIt provides the same benefits of laparoscopy to a patient population that may not normally have that access and that access normally is in a downtown tertiary center, and now we have it in the community,\u201d she says.\u00a0<\/p>\n
Chan performed the first robotic hysterectomy at William Osler last October, and since then, he and Skolnik have used the technology every week.\u00a0<\/p>\n
\u201cWe prioritize patients with elevated BMIs because of the benefits and because of the limited access in the GTA, but we absolutely we operate patients of all BMIs and all comorbidities, as long as they go through the same assessment to ensure that they\u2019re safe for surgery,\u201d Skolnik says, adding that patients undergoing a hysterectomy with the DaVinci robot do not need to do anything additional to prepare for their procedure.\u00a0<\/p>\n
\u201cIt\u2019s the exact same preparation as for laparoscopy,\u201d she says.<\/p>\n
Skolnik also says patients report easier recoveries, with some even going home the same day as their procedure.\u00a0<\/p>\n
\u201cI\u2019ve actually had quite a number of patients go home the same day after their hysterectomy, which has been wonderful,\u201d she says, adding that some patients also report minimal discomfort.\u00a0<\/p>\n
\u201cCalling my patients a week or two weeks after their surgery and just seeing how much better they feel, how much their pain is reduced, that\u2019s one of the best parts of my job.\u201d\u00a0<\/p>\n
Regarding other feedback, Chan agrees that offering residents surgery closer to home is highly beneficial.\u00a0<\/p>\n
\u201cPeople having their procedures locally to where they live, I think that\u2019s gotten very good feedback,\u201d he tells INsauga.com.\u00a0<\/p>\n
\u201cBefore, if you had elevated BMI patients with atypical hyperplasia (a pre-cancerous condition), you\u2019re referring them downtown or other centers, and they have their own wait lists, so I think patients appreciate having their surgery in their local area.\u201d<\/p>\n
Chan also says that patients who are already being treated in an Osler hospital (the health care organization operates both Brampton Civic and Etobicoke General) can now be referred for surgery within the same health system\u2013one they\u2019re already familiar with.<\/p>\n
For Chan, the technology represents a huge benefit to Osler overall.<\/p>\n
\u201cWhen you think about equity of access to technology, it was very important for this to come here. When you get equity of access to technology, you don\u2019t just give patients that, you also bring in surgeons,\u201d he says, adding that Osler can now attract physicians with training in robotic procedures.\u00a0<\/p>\n
\u201cThis puts us in a really great playing field that if you\u2019re robotically trained, you can come to a robotic hospital.\u201d\u00a0<\/p>\n
And while the DaVinci robot benefits larger patients who need hysterectomies, both Chan and Skolnik emphasize that robotic surgeries are increasingly used and benefit all patients.\u00a0<\/p>\n
\u201cI think that the robot serves everybody well, not just those with elevated BMI and in fact, many American practices are all robotic practices,\u201d Chan says.\u00a0<\/p>\n
\u201cBut it provides an option that someone with an elevated BMI did not have in our community before.\u201d<\/p>\n
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