Possible Complications from Robotic Assisted Surgery

When it comes to any surgery, it’s important to understand the procedure before determining with your doctor whether it’s the right option for you. With some cases of ovarian cancer, an increasingly popular option for ovarian cancer is robotic assisted surgery, which uses small instruments to operate through very small incisions.

In this minimally invasive procedure, rather than a surgeon opening up a patient’s entire abdomen from rib cage to pubic bone, referred to as “open surgery,” the entire procedure is completed with about five centimeter-long incisions around the belly button using cameras and robotic tools.

The robotic procedure differs slightly from traditional laparoscopic surgery, which is sometimes called “straight stick.”  While the incisions are similar, in the straight stick procedure a surgeon will manipulate the tools with their own hands rather than with robotic assistance.

While both minimally-invasive procedures result in less blood loss than traditional ovarian cancer surgery, the robotic surgery is considered more precise. The internal cameras used for the surgery magnify the view by about 20 times, and the robotic tools can access smaller spaces and stitch smaller sutures.

What is Robotic Surgery?

While the name suggests that the surgery is automated through robots or artificial intelligence, this is somewhat misleading. “I sometimes think of it as a misnomer,” says Dr. Albert Pisani, gynecologic oncologist at Sutter Bay Medical Foundation in the Bay Area of California. “The robotic instrumentation is just a tool that the surgeon uses to control the laparoscopic instruments.”

In other words, it is the surgeon, not a robot, controlling the instruments. The tools are called “robotic” because they are designed to operate like a human hand within the body.

Robotic surgery is performed through a series of small incisions, usually around five in total, of less than a centimeter each. This makes the procedures significantly less invasive than open surgery. While robotic surgery is not an option for all ovarian cancer procedures, it can reduce recovery time and pain after surgery due to the smaller incisions involved.

What Are the Risks?

Because it is less invasive than open surgery, robotic surgery can also mean a lower risk of complications. However, it isn’t entirely risk-free. “Robotic surgery is a major surgery,” says Dr. Pisani. “Just because it’s minimally invasive doesn’t mean it doesn’t have any risks.”

Potential complications include infection, blood clots, bleeding, and damage to the internal organs. According to Dr. Pisani, “Side effects or complications for robotic surgery are pretty much the same types of complications that you can get with open surgery, but occur less frequently.”

There are also some risks that are unique to robotic surgery, such as damaging internal organs through the small entry points. In a robotic surgery, after the surgeon makes the incisions, they insert small devices called trocars. The trocars act as a portal into the body, providing an entry route for instruments like scissors and staplers.

Occasionally, complications can arise when these trocars are first inserted. “Sometimes we can damage organs upon entry,” says Dr. Pisani. This organ damage on entry is different with robotic surgery than with open surgeries, because it is performed through such a small incision, making repairing the organs a different kind of challenge.

Bleeding is another possible complication that can vary between the two types of surgery. “You may or may not have more bleeding with an open surgery or a laparoscopic surgery,” says Dr. Pisani. While in general, robotic surgery is associated with less bleeding than a large open surgery, this might not hold true for all people. Significant bleeding can sometimes occur with laparoscopic surgery.

Robotic assisted surgery tends to be lower risk and have shorter recovery times than open surgery. In some facilities, patients can often go home the same day as the two- to four-hour procedure, and will quickly return to their regular diet and daily routine, often without requiring prescription painkillers.

Who Should Consider Robotic Surgery

Robotic surgery for ovarian cancer is a minimally invasive attempt to remove all visible disease from the body with minimal blood loss and improved outcomes, but it’s not right for everyone. It’s best for patients with early-stage disease and cases where the disease is more localized in the body. If the cancer has spread beyond the pelvis, a doctor might recommend traditional open incision surgery to ensure more accurate and complete removal of disease.

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