Some might say that Victor Cherfan, DO, an obstetrics and gynecological surgeon at ProMedica Bixby Hospital, is working to make open hysterectomy a surgery of the past — at least for his patients who qualify for a less-invasive surgical option.
Approved by the Federal Drug Administration in 2013, the single-site robotic hysterectomy via the daVinci Surgical System is becoming a viable option for women with gynecological problems. Unlike traditional hysterectomies, which require a larger incision or multiple cuts and longer patient recovery, the single-site procedure requires only one incision — two centimeters long through the umbilicus, or bellybutton — in which a gel port, camera, two operating instruments and an assistant port are inserted to assist the surgeon
“A common misconception is for the patient to think the robot does the surgery and I’m not in the room,” Dr. Cherfan said. “The robot does nothing without me.”
Dr. Cherfan Becomes First & Only Single-Site Hysterectomy Robotic Surgeon in the Region
Not every surgeon is equipped for the single-site robotic hysterectomy, and Dr. Cherfan is one of the few doctors in Michigan and Ohio who is trained to perform it. He is also the first surgeon in the ProMedica system to complete the extensive training on single-site hysterectomy. Intuitive Surgical makes the daVinci surgical robots found at many ProMedica hospitals today.
“You can’t just go from open hysterectomy or traditional laparoscopic hysterectomy to single-site robotic hysterectomy,” Dr. Cherfan said. “First, you have to successfully train for the daVinci multi-site hysterectomy, which requires 3-5 small incisions in the abdomen.”
This training includes a combination of online and live cases, labs with live dissections, and the ability to perform many multi-site procedures with precision. If you’ve proven yourself an expert robotic surgeon, then you can train for the single-site procedure, which requires even more online training and live labs.
With several years of multi-site robotic hysterectomy experience, and the required training completed, Dr. Cherfan performed his first single-site hysterectomy on a patient on Thursday, February 27 at ProMedica Bixby Hospital.
Considering the Options
If it’s been determined that a patient requires hysterectomy, Dr. Cherfan will go over all of the options.
Open hysterectomy: In this procedure, a large 5-7 inch incision across the stomach is made and the uterus is removed. Patients require more hospital and recovery time and will be left with a visible scar. “My last resort would be an open hysterectomy,” Dr. Cherfan said, explaining the surgery is much more high-risk.
Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the stomach, or one small cut made in the belly button. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen. “With the laparoscopic procedure, the instruments go straight in and the jaws open, but they can’t turn,” Dr. Cherfan said. “Additionally, there’s a depth issue with laparoscopic because everything appears two dimensional.”
Vaginal hysterectomy: The surgeon makes a cut in the vagina and removes the uterus through the incision.
Robot-assisted laparoscopic or single-site hysterectomy: This procedure is similar to a laparoscopic hysterectomy; however, the surgeon controls a sophisticated robotic system of surgical tools from outside the body. This technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen. “Robotic surgery instruments are wristed, meaning they can move with seven degrees of articulation,” Dr. Cherfan said. “If I turn my wrist a little, the instrument will do the same thing. Basically, it’s taking your hands and shrinking them to the size of the instruments. You still have complete control, as if your hands are inside the patient. The advantage is that you have great ability to do fine dissections that are more difficult.”
The Perks of Being A Robotic Surgery Patient
Dr. Cherfan typically performs 50 to 70 hysterectomies a year, with almost all of them qualifying for a robotic procedure. Because the technology is new, an ideal candidate for the single-site surgery should have a normal sized uterus, maintain a healthy BMI and have had few previous surgeries.
“When you’ve had previous C-sections and multiple previous abdominal surgeries, it can get complicated,” Dr. Cherfan said. “Even when complicated, almost all of my patients will have either a single-site or multi-site minimally invasive hysterectomy.”
And for those who do qualify, the benefits of minimally invasive surgery, compared to open hysterectomy, are apparent.
“Before 2005, 65% of women were having traditional open hysterectomy, which we know has a higher complication rate, requires a longer hospital stay and more time off work, creates more pain, and leaves a bigger scar,” Dr. Cherfan said. “That rate has dropped to 30% nationally since implementation of robotic surgery.”
The open hysterectomy rate has dropped significantly at ProMedica Bixby Medical Center with more patients opting for minimally invasive surgery. In fact, Dr. Chefan has only completed one open hysterectomy in the past three years.
And his first single-site hysterectomy two weeks ago was a successful breakthrough.
“The patient had the same outcome she would have had with the multi-site procedure, except there was only one incision,” Dr. Cherfan said. “While speed isn’t the ultimate goal, the operation took less than two hours to complete, and the patient went home the next day.”
For Dr. Cherfan, robotic surgery is really about improving the patient’s quality of life.
“My patients are out of the hospital within 24 hours after their operations, off pain medications within a few days, and back to work and normal daily activities within a week.”
To find out if gynecological robotic surgery is right for you, please visit http://promedica.org/GynecologicRoboticSurgery.