Robotic Gynaecological Procedures at University Hospital Limerick

Robotic Gynaecological Procedures – Pictured in front are Maura Tully, CNM2; Ms Uzma Mahmood, Lead Robotic Gynaecologist; and Roland Pika, Staff Nurse; and, back, theatre staff Joslen Fernandes, Staff Nurse; Margaret Stritch, Staff Nurse; Tushar Utekar, Surgical Registrar; Jennifer Enright, Surgical SHO; Eileen Williams, CNM2, and Mary O’Dwyer, Staff Nurse.

Robotic Gynaecological Procedures at University Hospital Limerick

Women’s health in the MidWest has advanced with the expansion of the robotic surgery programme at University Hospital Limerick to include gynaecological procedures.

Consultant obstetrician/gynaecologist Ms Uzma Mahmood performed the first such procedure in Limerick on the Da Vinci Xi Dual Console robot in January 2019. Seven gynaecological procedures have been carried out with the robot to date.

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In 2016, UHL became the first hospital in Ireland to perform colorectal, renal and adrenal surgical procedures using the state-of-the-art robotic system. Cork University Maternity Hospital has pioneered robotic surgery in gynaecology in Ireland. Ms Mahmood trained in robotics in Cork and in January 2019, UHL launched its own robotic gynaecological programme.

The Da Vinci system provides gynaecological surgeons with a groundbreaking alternative to both traditional open surgery and conventional laparoscopy. The surgical robot enables surgeons to perform even the most complex and delicate procedures through very small incisions (8mm) with unmatched precision while increasing the likelihood of a fast recovery and excellent clinical outcomes.

Ms Mahmood, the Lead Robotic Gynaecologist, said: “It is fantastic to have this state-of-art-platform for better patient outcomes. Patients who have a hysterectomy via the robotic procedure have reduced blood loss, less post-operative pain reduced the length of hospital stay by four days and a quicker return to normal activities than patients having any other methods of surgery”.

Maura Tully, CNM2; Ms Uzma Mahmood, Lead Robotic Gynaecologist; and Roland Pika, Staff Nurse, in Theatre 7 at University Hospital Limerick with the Da Vinci Xi Dual Console Robotic Surgical System

Robotic procedures can also help preserve fertility. In the case of a myomectomy, for example (involving the removal of uterine fibroids relatively common in Caucasian women), an open procedure comes not only with the usual risks and increased the length of stay but also an increased risk of hysterectomy.

Not all women are suitable for robotic surgery but those women for whom it was an appropriate option had been positive about the choice they made, Ms Mahmood said. “Once women fulfil the criteria for robotic surgery, they tend to be quite positive about it. I can see demand will increase because nobody wants an open procedure if they can have minimally invasive surgery. Who would want to stay five days in hospital if it is possible to stay just one night? The patients I have seen to date have been so happy to go home the next day. I have met women at the six-week check-up who were happy to have had only minimal scarring that you can hardly see at 6-8 weeks. I can definitely see an increase in demand and we are hopeful with the addition of a second consultant with an interest in robotics this year that we will increase access for these women.”

For complex hysterectomies and other gynaecologic procedures (e.g. myomectomy and sacrocolpopexy), robotic-assisted surgery with the Da Vinci surgical system may be the most effective, least invasive treatment option. Robotic-assisted surgery enhances the surgical technique for patients where it is difficult to carry out the surgery.

Robotic gynaecological surgery has an advantage of a three-dimensional field, greater surgical precision, decreased surgeon’s fatigue and tension tremor, as well as added wrist motion for improved dexterity and ease of suturing.

It offers a unique chance to bridge the gap between laparotomy and laparoscopy by shortening the learning curve, allowing an immersive view of the surgical field, and giving the unprecedented range of motion of robotic arms with a filtered tremor. 

Future gynaecological surgeons will be trained through an immersive reality simulation. Altogether, computer-enhanced surgical systems will make minimally invasive surgery safer and quicker.

Suzanne Dunne, Head of Strategy at UL Hospitals said: “It is great to see the strategic plans for the Robotic Surgery Programme come to fruition. Ms Mahmood is the fifth surgeon to be trained in robotics in University Hospital Limerick. There are plans to have a second Gynaecology Surgeon trained by the end of 2019. The programme is only made possible through the ongoing dedication of the multi-disciplinary teams”.

In 2016, UHL became the first hospital in Ireland to perform colorectal, renal and adrenal surgical procedures using the state-of-the-art Da Vinci Xi Dual Console robot.

The first-ever live stream of robotic surgery in Ireland was carried out at UHL in November 2016 and earlier in 2017, UHL hosted the inaugural Irish training course on robotic surgery.

The Da Vinci Xi technology has particular advancements not available with standard keyhole surgery. The 3D-HD visualisation provides surgeons with a highly magnified view, virtually extending their eyes and hands into the patient, almost as if the surgeon were ‘standing inside the abdomen and reaching out to the organs’.

The robot is secured or ‘docked’ to the patient and has 4 working arms (each requiring only an 8mm skin incision) to which operating instruments are attached.  Once docked, the robotic arms and instruments are controlled by the surgeon, or surgeons, who are seated at the consoles nearby. The instruments are extremely precise, with no tremor, and they can, in fact, achieve activities not possible with the human hand, though they would never replace the human hand, they are completely controlled by the surgeon.

Valued at approximately €2.6m, the Da Vinci Xi robot and equipment was donated by the Midwestern Hospitals Development Trust and funded with the generous support of the JP McManus Benevolent Fund.

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