After suffering from acutely painful menstrual cramps and excessive bleeding, a 31-year-old nulliparous, single female patient had been diagnosed with uterine fibroids. Faced with the possibility of a hysterectomy, the patient learned from her local OB-GYN about an alternative surgical procedure. A myomectomy would remove the fibroid tumors, resolve her symptoms, and allow her uterus to remain in place, thus allowing for the possibility of pregnancy in the future.            

Patients looking for an alternative to a hysterectomy for the treatment of uterine fibroids are often referred to Baptist OB-GYN surgeon John Russell Wooley, MD, who was among the first wave of surgeons trained nationwide on the da Vinci Surgical System.

Merely months after Arnold Advincula, MD, and his colleagues described the robot-assisted laparoscopic myomectomy in a 2004 report that played a pivotal role in the FDA’s approval for use of the da Vinci Surgical System for gynecologic surgical procedures, Wooley traveled cross-country to be trained on the highly technical equipment initially developed for military use.

“When I came back home after that trip, my wife told me she hadn’t seen me that excited since I was in medical school,” said Wooley. “I knew right away this technology was truly amazing.”

The difference between conventional laparoscopy and robotic laparoscopic surgery boils down to several key points, said Wooley.

“With the robotic EndoWrist instrumentation and intuitive motion, the tool mimics your wrist and hand movements,” he explains. “Sitting at a console with my fingers in a device, I can move the instruments just as I could if I had my hands on them in an open case. That’s a huge advantage over straight stick laparoscopy. Also, two cameras with high-definition video allow you 3-D depth perception you don’t get with conventional laparoscopy. The scope may also be zoomed for up to 10-fold magnification. Visualization is better, which is advantageous when you’re looking into a deep pelvis.”

These technological advantages offered by the da Vinci robotic system allow for increased surgical precision, less blood loss, less febrile morbidity, less patient pain and therefore, a shorter length of stay.

“The improved ergonomics offered by a surgeon sitting at a console during difficult robotic laparoscopic cases allow for decreased surgeon fatigue,” said Wooley, “and are another significant advantage over conventional laparoscopy.”

Wooley received additional training from some of the nation’s most prominent OB-GYN robotic surgeons to bring additional expertise to Baptist.

“Baptist is such an excellent place for robotic surgery and surgery in general because we have the Baptist for Women Center of Surgery dedicated to women’s surgical specialists,” he said. “The center is a new, state-of-the-art facility with convenient access for patients. We have a dedicated room for the da Vinci robot. Most importantly, there are dedicated teams of nurses and technicians accustomed to dealing with the robot. Therefore, it’s a much more efficient option.”

Wooley performs robotic myomectomies on patients with uterine fibroids when it’s possible to spare their uterus for fertility preservation, among other reasons. He also performs robotic hysterectomies at the Baptist for Women Surgery Center.

“Uterine fibroids are very common, benign, smooth muscle tumors,” explains Wooley. “In fact, they’re one of the most frequent reasons for hysterectomies. But if you have patients that are symptomatic—most commonly with pain, excessive bleeding, or severe menstrual cramps—and have significant uterine fibroid pathology but have not completed their family, they may not want a hysterectomy. A myomectomy will remove the fibroids and leave the uterus intact, thereby maintaining the patient’s fertility potential.”

Not too long ago, conventional myomectomies were always performed by making an incision for an open procedure and removing the uterine fibroids. Now, many different approaches exist for myomectomies, depending on the number, size and location of the uterine fibroids. 

“When the myomectomy can be done robotically, the dexterity and technology behind the robot are very beneficial for removing fibroids,” said Wooley.

To perform a myomectomy, Wooley makes an incision with the da Vinci robot through the myometrium down to the fibroid, which is grasped and dissected from the surrounding myometrium. The area where the myoma was located is sutured in layers.

However, the da Vinci system doesn’t always eliminate the need for an abdominal myomectomy. For example, a recent patient of Wooley’s had nine or 10 fibroids that were so large, they were visible abdominally. “A robotic myomectomy wouldn’t have been appropriate in this patient,” he said. “I was very comfortable recommending an open procedure. Even though it’s advantageous to perform surgery in the least invasive way possible while still getting optimal results, every patient is individual and should be assessed for treatment as such.”

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