Robotic Surgery for Infertility

Robotic surgery for infertility at a glance

• Robotic surgery is an excellent surgical option for many infertility procedures because it allows the surgeon to perform complex maneuvers in compact places that would otherwise not be possible.
• Robotic surgery may be used to treat these causes of infertility:
  • Uterine fibroids
  • Endometriosis
  • Fallopian tube disease
  • Ovarian cysts
  • Tubal ligation reversal.
• A form of minimally invasive surgery, robotic surgery utilizes robot-assisted, computer technology to enhance the ability of the surgeon, who directs the robotic device from a console adjacent to the patient.
• The physicians at Reproductive Science Center of New Jersey (RSCNJ) use the da Vinci robotic system at leading hospitals in the area.
• Benefits for infertility include smaller incisions, less post-operative pain, quicker recovery and shorter hospitalizations.

What is robotic surgery for infertility?

At RSCNJ we perform robotic surgeries with the da Vinci Surgical System. Our physicians are specially trained in robotic surgery, and with the use of this advanced surgical system, they can perform precise surgical maneuvers through micro-manipulation control of the robotic surgical arms.

Here’s how the surgery works. Small, minimally invasive incisions allow for a high-definition, 3D camera and surgical instruments to be inserted into the patient, via robotic arms that are positioned directly over the patient. After placement of the robotic instruments, the surgeon then sits at a console and uses foot/hand controls to precisely manipulate the robotic arms, allowing micromanipulation of the surgical instruments.

The surgeon has a three-dimensional view of the operating area at all times, which is superior to the two-dimensional view offered in traditional laparoscopic surgery. The surgeon moves his hands and the robot performs the same movement, although on a much smaller scale to complete precise surgical maneuvers.

The robotic hands/wrists are very small (less than one-third of an inch in diameter). These can be manipulated in 360 degrees and at very precise angles that a human wrist/hand cannot accomplish. A variety of instruments can be attached to the robotic arms, allowing the surgeon to perform precise incisions, suturing, tissue manipulation and other surgical maneuvers. The da Vinci Surgical System has “motion scaling” software that eliminates any shaking of the surgeon’s hands before those movements are translated to the robotic hands within the patient.

Infertility conditions treated by robotic surgery

Uterine fibroid removal, or myomectomy, is often performed robotically. Whereas traditional myomectomies might require the use of a larger incision, called an abdominal myomectomy, robotic surgery allows for placement of several smaller incisions and a quicker recovery time.

Endometriosis occurs when tissue of the endometrium (cells that line the uterus) implants outside the uterus. This can cause cyclical pelvic pain and infertility. Lesions and scarring caused by endometriosis can be removed via robotic surgery.

Fallopian tube damage can prevent fertilization of an egg by blocking sperm. Robotic surgery may be used to remove or reduce the scarring causing the blockage and infertility, and in select patients may be used to reverse prior tubal sterilization procedures.

Ovarian cysts may cause or contribute to infertility by disrupting normal ovulation. An ovarian cystectomy (cyst removal) can be done by robotic surgery to remove the cyst but keep the ovary intact and functioning.

Tubal ligation reversal is the undoing of a tubal ligation, an elective form of sterilization in which a woman’s fallopian tubes are “tied” to prevent pregnancy. Robotic surgery is a minimally invasive method to perform this surgery.

Benefits of robotic-assisted surgery for infertility

Benefits of robotic-assisted surgery over traditional open surgery can include:

• Less pain, scarring and blood loss
• Faster recovery time and shorter hospital stay
• Reduced chance of post-surgical complications, including infections.

Benefits cannot be guaranteed and are dependent on many variables related to the procedure and the patient’s specific condition and health. Our surgeons will discuss the option of robotic surgery with the individual, taking into consideration her unique situation and preferences.

Risks and considerations of robotic surgery for infertility

Certain patient conditions can increase the risk of complications from robotic surgery, including existing conditions of the heart or lungs, obesity, excess alcohol intake, prior abdominal or pelvic surgery and diabetes. Risks specific to robotic-assisted surgery are potentially a longer time for the operation and thus a longer time under anesthesia. Temporary nerve pain or damage may also result from the positioning of the patient during the surgery. Our physicians will completely discuss these risks with each patient, and determine whether robotic surgery is the best option on an individual basis.

Comparisons of robotic and open surgeries

*Data based on procedures performed by Dr. William Ziegler.

How the da Vinci Surgical System works