Scripps Health: How To Treat Common Women’s Health Conditions With Robotic Surgery

(uplifting music) – Hi, I’m Susan Taylor,
with Scripps Health in San Diego, California. Are you one of the millions of women in the US who suffer from severe pain in your pelvis area,
abnormal or heavy bleeding, fibroid tumors in your uterus, pelvic prolapse, it’s the slipping or falling of your pelvic organs? In the past, these
conditions have required pretty extensive surgery,
but robotic surgery has really changed the game, making these types of surgeries
much less invasive. Here to talk about gynecological robotic surgery are two
OB-GYN robotic surgeons. Dr. Bobby Garg is a Scripps Clinic doctor who operates at Scripps Mercy Hospital in San Diego, and Dr. Vaale Gafori with IGO Medical Group,
who performs surgery at Scripps Memorial Hospital in La Jolla. Thanks for being with us. – [Both Doctors] Thanks for having us. – So let’s go through,
kinda laundry list this. Let’s go through the most common types of gynecological conditions
that require surgery. Let’s talk about severe
pain in the pelvis. What causes it? What are the symptoms? Who gets it? – Pelvic pain is probably one of the more common complaints that
we hear about in gynecology. There are many different causes. Endometriosis is probably
one of the more common ones. It’s the growth of the
lining of the uterus outside of the uterus in the abdomen, and also adenomyosis, which is a growth of the lining of the uterus in the actual walls of the uterus. And pelvic inflammatory
disease can cause pelvic pain and also infertility. Ovarian cysts can cause pelvic pain. – What about fibroid tumors? – Fibroid tumors can
also cause pelvic pain in some cases, depending on where they are and how large they are. Overall–
– But these are not cancerous, though, fibroid tumors. – For the most part, no. Occasionally they can be. So an individual doctor can look at some of the signs and see if there’s any suspicion of that, and any time we do surgery,
there’s an analysis done on all the tissue to make sure. But in general, they’re
usually benign tumors. But pain and bleeding are some of the major symptoms we see from that. – And what about frequent urination and difficulty emptying the bladder? – When fibroids are very large, they can cause those symptoms. – And also fertility issues, as well? – Yes. Fibroids that grow in the lining of the uterus can cause problems with fertility, and so sometimes they need to be removed before someone tries to get pregnant. – And what is a myomectomy? – That’s when you just remove
the fibroid tumor itself. So when we treat fibroid, some
people require a hysterectomy to remove the entire uterus, but a lot of people, if they wanna not have that extensive a surgery, or want to be able to get pregnant afterwards, then we really try to do the least amount of surgery possible, which
is just to remove that tumor. – So if you have that myomectomy, can you then get pregnant
and carry a child to term? – Yes, in most cases. – And the different types of
myomectomies, what are those? – There are hysteroscopic
myomectomies, which– – There’s a mouthful (laughs). – Yeah, which are actually
done through the vagina, and the fibroid is actually
removed through the vagina. There are open surgeries,
which are the big, extensive surgeries, where
we make big incisions, and those are typically reserved for patients who have many,
many very large fibroids. There are laparoscopic myomectomies, and then robotic-assisted
laparoscopic myoectomies. – And once that fibroid tumor’s
taken out, can it return? Can it come back? – Yeah, up to half the time, it can. It is very, very common thing. So we really choose that surgery wisely for somebody who
has very specific reasons for wanting to do that,
especially getting pregnant later. – And it can come back for
somebody who is premenopause. What about postmenopause? – Usually not postmenopausal. That’s a little bit more concerning if it grows postmenopausally. – Yeah, these tumors–
– What does that suggest? – Well, the tumors are
typically hormone-dependent, and so in menopause, your
hormone levels go down, so it’s a little bit more
uncommon to have that. So women that are over age
60 that have new fibroids, that’s a bit concerning,
for possibly a sarcoma, a leiomyosarcoma, which
is the cancerous growth. – Cancerous. So how do you get rid of the
fibroid tumor permanently? – Well, permanently, really, the only true permanent
cure is a hysterectomy, so removing the entire uterus. So there’s nowhere a fibroid could possibly grow back again after that. – And there’s no way to get
pregnant after that, as well. – Right.
– So that’s what we have to balance out. – So how do you tell the difference between a fibroid tumor
and a cancerous tumor? – Well, unfortunately, there
isn’t a real reliable method to do that other than pathology, when the pathologist
actually takes the tissue, the biopsy that we do, and looks
at it under the microscope. We do start with ultrasound, and sometimes we’ll refer patients for MRI if we have some suspicion of something, but typically it’s really at the time of surgery that the
full diagnosis is made. – And then talk about pelvic prolapse. What is that? – So pelvic prolapse is when any part of the pelvic organs,
whether it’s the bladder, the uterus, vaginal tissue, the muscle and the ligaments that support that tissue just get weaker over time and they can sometimes start sagging and literally pushing into the vagina, and sometimes even protruding outwards. And they can cause pain, pressure, urinary problems, all
sorts of things like that. – And at what age of
life does that happen? – It can theoretically happen anywhere, but it usually is a little bit older, more common postmenopausally,
and more common in people who’ve had multiple childbirths. – So at what ages do women
have all of these issues? Are these things later on in life? Does it happen in conjunction
with pregnancy, for example? – Well, a lot of these symptoms do occur before people try to get pregnant, with pelvic pain, fibroids, but they’re usually in the childbearing
age, typically. Abnormal bleeding can occur at any point in your life, though. – And in the past, these conditions have required major surgery, like a big cut in the abdomen, right? So talk about minimally
invasive robotic surgery, ’cause I know you use the
da Vinci Surgical System that was approved by the FDA back in 2005. How does it work? – So laparoscopic surgery was kind of the first major advancement for minimally-invasive surgery. So what that involves is, rather than that big open incision
across the stomach, three or four smaller incisions,
each less than an inch big. That surgery is an excellent surgery. It’s still something we
still frequently use, but it does have its limitations, in terms of how much range of motion you have, how much instrumentation
you have available. The da Vinci, robotic
surgery’s a bit of a misnomer that kind of implies that
the surgery’s being done by some sort of machine. What the actual robot is
is it’s a large machine that holds all of those
laparoscopic instruments for us, and we still control all of them, but it allows us a lot more dexterity and a lot more options for the types of surgeries we can do than we could just do with only
laparoscopic surgery before. – And so you’re saying
the laparoscopic surgery, there might be two or
three little tiny holes, but with the da Vinci robot, you’re saying it’s a single-site surgery? – No, it’s still the two
or three little holes, but those instruments, there’s a lot more options with them and they have a lot more articulation, a lot more range of movement, and when we look
inside the da Vinci camera, it’s actually a 3D, high
definition visual field compared to kind of the regular
two-dimensional screen. So having that 3D visualization for us is, it makes such a huge difference for hand-eye coordination.
– And there’s a good amount of magnification, and honestly, sometimes you get better views of the pelvis than you
do on open surgeries ’cause you can get the
camera very close up. – So it’s magnifying at how many times? Isn’t it like 10 times, or something? What your eye can see?
– It can go up to that much. Yeah. – And talk about single-site surgery. – So single site surgery is a variation of the da Vinci surgery, where it’s just one incision
inside the belly button, and you can actually
put multiple instruments and the camera all
through that one incision. It’s still relatively
early in its formation, so it’s very limited at this point. There’s a small handful of types of surgeries we can do with that. There is a lot of advancements coming down the line, where it really will, I hope someday, become more of a standard where we can really just narrow it down to one small, almost invisible, incision inside the belly button. – So in a couple of
minutes, we’re gonna talk about who is a candidate for minimally-invasive robotic surgery and who is not a candidate for it. So just hold this thought. We’ll come back to this
in a couple of minutes. Let’s talk about the
benefits of robotic surgery. I know that you talked about the range of motion and the dexterity. So you’re saying that the da
Vinci robot can do things, and go into different positions, that your hands really can’t do, right? – Yeah, the instruments can. They have almost, or
they do have 360 degrees of rotation, which, can’t always
do that very well yourself. – (laughing) Can’t do
that with ours a bit. – And the computer
translates our movements into smaller, more precise
movements with the robot. And then the small
incisions actually help, in terms of recovery for patients. Instead of having a large incision, they have these tiny little incisions. They can even go home
that day of the surgery which is amazing, and then they can return to work much earlier. – So let’s elaborate on that a little bit. It is much less invasive, obviously, than cutting open the abdomen, faster healing, you’re saying, cuts recovery time by how much? Can you put a percentage on it? – Yeah, most of our,
with the open surgery, most patients will stay in the hospital for up to three to four
days for a routine recovery. For the da Vinci surgeries, most of our patients go home the same day, and then the return to work can be as long as four to eight, even 12 weeks, with an open surgery. With a da Vinci surgery,
I’ve had patients go back as soon as the first week after surgery, and most patients, within
about two or three weeks. – [Susan] That is wild. – It is, and it’s really important now that probably around 50%
of the workforce is female. So it’s really important. – Are there risks to this surgery? – The risks are essentially
the same as any surgery we do. So every surgery has those inherent risks, of bleeding, infection, all sorts of other complications, and those aren’t necessarily different
with the da Vinci robot. In fact, a lot of the studies
show a lot lower complications when it’s in the hands of
highly-skilled surgeons compared to the open surgery. – Some of the surgeries can actually be almost bloodless, which is incredible. – That’s incredible. And does using this da Vinci robot, does this actually shorten
the time of surgery? – In some cases, it can. It really, time-wise, it’s probably about the same, especially once you gain a certain level of experience. Obviously, when you’re
first getting familiar with the technology, it does
take a little bit longer at the beginning, but then once you become adept at it,
time-wise it’s about the same. But that recovery is really
where that maximum benefit is. – Yeah, and having a dedicated team at our hospital, at the Scripps hospitals, is really important, too. We have the scrub nurses
and circulating nurses that work with the robot all the time, and so they really know how to set up much faster and get things
going for us and assist us. – Now, a lot of women
have pain in their pelvis. They have heavy bleeding during their periods, and
after you’ve had a baby, maybe some bladder issues,
maybe leaking, going frequently. So when should you take these things seriously and say, “You know? “I really need to go see a
doctor about this stuff.” – Any type of prolonged
abnormal bleeding is something that you need to see us for, excessively painful periods, bleeding in between periods, is typically something we would like to see. Any type of postmenopausal
bleeding is considered something that needs an evaluation. – I would say, especially for pain, or bleeding, or cramping, or anything like that, anything that lasts for more than one period or more than one cycle, it’s generally worth at least checking to make sure if there’s something else going on. In terms of urinary issues,
I would say the second you had experienced anything, it’s an issue worth looking into. It’s one of the most under-reported things that we deal with. – Interesting. Why is that? – I think a lot of it is just cultural or generational, where people are just taught that this is
kind of a normal thing that happens, either with age or after childbirth.
– After you have babies. – For a lot of people it’s embarrassing to bring up unless it’s specifically asked that we try to go out of our way to really get that information from people rather than wait
for people to volunteer that. But any urinary issues at all really should be brought up right away. – So we referenced this
a couple of minutes ago. Let’s come back to this. Who is a candidate for
this minimally-invasive robotic surgery and who
is not a candidate for it? – Well, most patients
probably could be a candidate. I would say any medical problems that would make it difficult for you to be positioned in the way that we need you to be positioned, or patients who can’t endure
longer surgeries might not wanna have this kind of surgery. – There are certain conditions where just a more extensive
surgery needs to be done. If the uterus is very, very large, if someone’s had a lot of
previous surgeries before, those kinds of things, but in general, there’s not kind of an overall set rule for who can get it, who can’t. It really is that individual evaluation, and for some people, they don’t even need something as advanced as da Vinci. There can be something
a lot less extensive than the da Vinci, like just
basic laparoscopic surgery. – We try to reserve the robotic surgeries for patients that have the little bit more complicated situation. So a normal tubal ligation or a small cyst that needs to be removed, we just do it, typically, laparoscopically. – Any final thoughts? – One thing I would say is that we’ve been using this technology here at Scripps for over 10 years now, and it’s across the entire Scripps system, and we have a really,
really thorough process here of safety and oversight, and it makes me feel a lot more secure because you do hear a lot of horror stories out there for patients
experiencing complications, and we really take that seriously here. We have a lot of oversight. We go through a lot of rigorous training, and I feel very safe operating here, and I know my patients are
in good hands operating here. – The training is really
extensive across the system, and it’s a phenomenal team
effort that goes into it. – And we really, we’re
together across all campuses. Vaale and I are at different hospitals and we’ve been collaborating for years, and we kind of maintain that
across the entire system so we all learn from each other. – [Susan] Any final thoughts? – I agree with everything he said. It’s a very good place to
have a surgery (laughs). – [Susan] There you go. Exclamation point. Thank you both very much. We appreciate it.
– Thank you. – According to US News and World Report, Scripps is ranked number one in San Diego and in the top 15 nationally
for gynecological care. If you’d like more information on gynecological robotic surgery, just click on the link or
go to Want more critical
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social media @scrippshealth. I’m Susan Taylor. Thanks so much for joining us. It’s our mission at Scripps to help you heal, enhance, even save your life. (inspirational music)

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