One day after having a grapefruit-sized growth removed from her ovary, a pregnant Jessica Drake walked out of Albany Medical Center with five small incisions and some Tylenol.
Most importantly, she was 16 weeks pregnant and her fetus was safe and sound after major surgery.
But the word “major” may no longer need to be attached to ovarian cyst removal surgeries and a slew of other normally invasive surgeries with the development of new robotic technology that only a few medical facilities in the nation possess and have the physicians trained to use.
Fortunately for 26-year-old Drake, Albany Med surgeon David Kimble is one of few surgeons who are trained and skilled to use the da Vinci robot, a relatively nascent technology that performs minimally invasive surgery as an alternative to open surgery or laparoscopy.
And the Dec. 28 surgery to remove an 11-centimeter ovarian cyst from Drake was the first time the technology has ever been used on a pregnant woman.
“She was about 16 weeks along when she was presented to us for referral,” said Kimble. “We thought either we take care of it now or we wait and it will be a much more challenging issue that could put the fetus at risk. So we knew we had this limited window of opportunity to treat her.”
If they had waited two more weeks, Kimble said removal of the cyst would have been impossible to perform laparoscopically, which is already a minimally invasive form of surgery that relies on several small incisions to reduce recovery time and pain.
The da Vinci robot technology essentially augments all of the benefits of laparoscopy, and Kimble doesn’t even need to be in the same room as the robot as it cuts into a patient.
It’s science fiction-esque to the medical novice but not all that fascinating to a surgeon skilled in its use.
“It’s a bit of a different mindset because you’re not physically at the patient’s bedside,” Kimble said. “You’re across the room or even in a different location entirely and you’re doing a surgery by looking through goggles that are connected to the robot’s console.”
With two controls at his hands and two at his feet, Kimble is able to manipulate the robot’s arms to make the proper incisions with instruments that are only about a quarter of an inch in size, he said.
“Compared to the much larger instruments that you use during traditional surgery, this allows for very meticulous, very fine surgery with very teeny-tiny incisions through robotic arms,” he said. “And that’s the beauty of it.”
It’s already unusual that a woman would undergo surgery while pregnant, he said. But what made Drake’s condition rare was the size and position of her cyst, which although benign caused pain to her and could pose risk to the fetus if it twisted and required emergency surgery.
Ovarian cysts occur in one out of 1,000 pregnancies, and if removal is necessary it is sometimes done laparoscopically. But the limited instrumentation used in laparoscopy would have required doctors to physically displace Drake’s uterus in order to detach the blood supply. The risk to the fetus was obvious.
The da Vinci robot required less manipulation and tissue damage to her uterus and did not open the womb or expose the fetus to large amounts of anesthesia. The benefits were obvious.
“The grand utility of it is you have that three-dimensional image of what you’re looking at,” said Kimble, who joined Albany Med last fall.
That depth perception can be helpful to surgeons who are used to the two-dimensional image that appears on a screen during laparoscopy, which uses a telescopic rod lens or a digital laparoscope. It allowed Kimble to manipulate the robot’s arms with the same precision as the human wrist as he disconnected Drake’s ovary and fallopian tube from her uterus. And it then allowed him to remove the 11-centimeter cyst section by section in the confines of a nephrectomy bag, generally used in kidney removal.
Although Kimble has performed more than 400 robotic surgeries — most during his time at St. Peter’s Hospital — he said the experience is still exciting for him.
“It’s truly in its infancy,” he said. “So this will be an evolution over time. And there are now just two different companies working on innovative robotic technology, and we can expect it to become more commonplace to see the adoption of robotic technology being used for different things.”
For example, as chief of Albany Med’s urogynecology and pelvic reconstructive surgery, Kimble has used the da Vinci for hysterectomies and to correct incontinence.
He is also one of about eight to 10 surgeons at the Albany hospital trained and skilled to use it, so patients are increasingly referred to the center for any number of operations.
“If you look at Albany Med, in general, for its use of the da Vinci surgery, we’re one of the most comprehensive facilities as far as the range of surgeries we perform with it,” said Kimble. “It could be cardiac, gastric bypass, incontinence, prostate or kidney cancer surgery. So very few centers across the country have that many specialties to use the robot for.”
Kimble said the robotic technology is also helpful in operating on overweight or obese patients, who, depending on the surgery, could require instruments with more dexterity and flexibility. The reduced recovery time the da Vinci provides makes it a growing surgical procedure among overweight patients, who are already more at risk for complications during recovery.
Albany Med is currently in the process of exploring opportunities to use robot technology for single-port surgery, a minimally invasive surgical procedure that requires that only one incision be made.
The day after her hour-long robotic surgery, Drake was able to go home, and the hospital reports that she and the fetus continue to do well. In a release issued last week by Albany Med, Drake said she knows how difficult recovery from a large incision can be, having undergone a previous C-section.
“I was up and moving that same night of my surgery,” she said of the da Vinci surgery. “It was pretty amazing. It’s important that other patients in similar situations know that this is possible.”
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