As he settles into a chair behind the console of the da Vinci Surgical System, Michael Werkema, MD, looks a bit like a gamer cozying up to an oversize virtual reality machine.
But this is no game. It’s the real deal.
Manipulating a set of levers at the da Vinci system’s console, Dr. Werkema has full control of the surgical instruments attached to the machine’s array of robotic arms.
He holds a huge responsibility: Those instruments are positioned deep in the abdomen of a woman lying on the operating table beside him.
The machine works as an extension of the doctor’s hands, only with more precision and control.
One of the system’s instruments—a high-definition fiber-optic camera—shows Dr. Werkema exactly what he needs to see, magnified by 10, on a video monitor in the operating room at Spectrum Health Butterworth Hospital.
The other slim instruments handle cutting, suturing and other intricate procedures.
“It’s kind of like operating a Wii video game,” says Dr. Werkema, an obstetrician and gynecologist with Spectrum Health Medical Group. “I’m moving my actual hands to do the motion that I want the instruments to follow.”
By providing a greater range of motion than a human hand, the instruments’ robotic wrists let the doctor maneuver the surgical tools in hard-to-reach places. The camera makes it easier for him to monitor his progress.
Dr. Werkema is part of a small group of Spectrum Health specialists who use the da Vinci surgical robot for gynecological surgeries. They often use it for minimally invasive myomectomy, which removes uterine fibroids.
Spectrum Health has three da Vinci machines. In addition to gynecological operations, they’re also used to perform urological, colorectal, cardiovascular and general surgeries.
A fibroid is a typically benign growth in the wall of the uterus. While many women have fibroids without even knowing it, others may experience symptoms such as back pain, abdominal pressure or heavy menstrual bleeding.
When fibroids are small, an OB-GYN may simply opt to keep an eye on them or prescribe medication to help them shrink.
When a fibroid is large enough to cause a patient discomfort, however—or when it’s aggressive enough to create a suspicion of cancer—a doctor may need to surgically remove it.
A hysterectomy will remove the entire uterus and any fibroids along with it, but that’s not often an appealing choice for women still in their childbearing years.
“There’s a lot of women who are still in those reproductive years that don’t want to sacrifice fertility,” Dr. Werkema said.
In such circumstances, a minimally invasive myomectomy is the answer.
The myomectomy of old required an abdominal incision, like a C-section, and it typically resulted in a one- or two-night hospital stay.
With the robotic myomectomy, on the other hand, women typically return home the day of their surgery and have a shorter recovery time.
“Usually by two weeks, most women are back to themselves,” Dr. Werkema said.
Some recoveries may be faster, some may be slower.
Barbara Van Polen underwent the robotic procedure in March and didn’t return to work for four weeks. But she had an unusually large fibroid—three times the size of a normal uterus—and her job as a kindergarten teacher involved a lot of bending and stooping.
To be safe, Dr. Werkema kept her off work for a month.
Still, Van Polen felt surprisingly good after surgery.
“It was amazing that I could be up and moving around so quickly,” she said. “I really felt good, for the most part.
“It certainly shortened my recovery time,” she added. “Less than a week after my procedure, I was driving.”
The potential of a shortened recovery time appealed to Van Polen, who wanted to get back to her classroom quickly. She also liked the idea of preserving her ability to have children.
When she learned that her insurance would cover the robotic procedure, it made the decision even easier.
“I would definitely recommend it as a good way to go,” she said. “It was easier on my body, and I thought Dr. Werkema did a great job.”
In Van Polen’s case, that job took the doctor about two hours of intense, precise work. Some myomectomy procedures can take up to six hours.
Big job, little incision
A doctor’s typical steps during a myomectomy procedure:
- Map out the incisions on the patient’s abdomen, positioning them so the robot’s arms can work from multiple angles.
- Make the incisions, each 8-12mm long, and insert the instruments, which are about the thickness of a Sharpie marker.
- Use the robotically controlled scalpel to make an incision in the uterus, separating the fibroid from the uterine wall.
- Suture the uterus so it can heal and support a potential future pregnancy. (The machine’s suturing function is its most important capability, according to Dr. Werkema.)
- Slip a plastic bag through one of the incisions and place the fibroid into the bag. By confining the tumor, the doctor can prevent its cells from spreading—an important precaution despite the rare risk of cancer. (This was a concern for doctors in Van Polen’s case, but her tumor ultimately proved benign.)
- Slice the tumor into small pieces inside the bag.
- Slide the bag out through an incision, arranging its contents in a long strip.
- Suture the incisions.
This meticulous process allows doctors to perform significant surgeries through the smallest of incisions.
Dr. Werkema said he often makes one of the incisions in the navel because it’s a less sensitive area and it hides the scar quite well.
Minimally invasive surgery is all about getting patients back on their feet as quickly as possible.
“We’re always looking for ways that we can improve women’s health,” Dr. Werkema said. “As our technology has grown and improved, we’ve been able to … improve on complex procedures and make our outcomes better.”