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Robotic Reproductive Surgery

Dr. Samuel Brown has been performing complex minimally invasive surgery for more than twenty years. In addition to advanced laparoscopy and hysteroscopy, we have also added robotic reproductive surgery to the Brown Fertility armamentarium.

Robotic Reproductive Surgery has brought the opportunity to perform complex reproductive surgeries through a minimally invasive approach. FDA approved in 2005 for gynecologic procedures, robotic surgery involves a surgical console where the surgeon sits and performs the surgery using finger controls. The surgical tower is at the patient beside with 4 surgical arms which mimics the physician’s movements inside the abdomen with 8 mm hands that can rotate 360 + degrees. The console provides the surgeon three dimensional vision and the tower can eliminate natural tremors.

Procedures currently offered include robotic tubal reversal and reconstructive tubal surgery, robotic myomectomy, and robotic reconstruction of mullerian anomalies.

For Robotic Tubal Reversals: Reversal of tubal sterilization is analogous to the “open” technique but with distinct advantages. Preoperatively, a semen analysis is obtained and ovulation or ovarian reserve is assessed. Also documented is a normal uterine cavity either via a hysterosalpingogram or saline infused sonogram.

Patients with good prognoses include those with a postpartum tubal ligation, or have a tubal length of at least 4cm determined at concomitant laparoscopy. In addition, the absence of other pathologies, such as endometriosis and uterine fibroids conveys a good prognosis.

Postoperative pregnancy rates with robotic tubal reversals are comparable to the open approach at 50% for up to one year. Patients are sent home the same day with average return to IADL (Instrumental Activities of Daily Living) of 5 days. Analgesic requirements are significantly less than with open surgery.

For Robotic Myomectomies: At Brown Fertility we have performed a large series of myomectomies for patients who desire fertility. Optimal candidates are those with less than 5 myomas, or a size of less than 10 cm. In addition, the myomas should not be more than 50% into the endometrial cavity. Preoperatively, we perform an ultrasound to determine the size and location of each myoma (as there is a lack of tactile feedback with robotic surgery).

Postoperatively, patients usually go home the same day, and return to activity within 48 hours- . They are encouraged to conceive from immediately to up to 3 months postoperatively depending on the extent of surgery. In a small series of those actively attempting conception, 40% conceived within 6 months with delivery via cesarean section at term.