In robotically-assisted laparoscopic tubal reversal, a standard laparoscopy is performed whereby visualization of the abdominal and pelvic organs is achieved by insertion of a fiber optic camera, the laparoscope, through a small umbilical or peri-umbilical (around the belly button) skin incision (typically 8 mm long).
Furthermore, as in a standard laparoscopy, additional ports (normally 3) are introduced after performing small skin incisions (all less than 8 mm long each) in various locations in the abdomen (typically in the lower and mid-abdomen, and occasionally the upper abdomen, depending on the procedure performed) in order to gain surgical access to the fallopian tubes. The difference between a standard laparoscopy and robotically-assisted laparoscopy comes next: instead of inserting laparoscopic instruments through previously-established abdominal ports that are maneuvered using the surgeon’s hands directly, robotic instruments (fine graspers, scissors…) are inserted through the abdominal ports and the robot’s arms are locked onto the laparoscopic instruments. The surgeon next relocates away from the operating room table (a surgical assistant remains at the patient’s side at all times) and to the robotics surgical console, located a few feet away from the patient in the operating room.
In the surgical console, the surgeon is served with a three-dimensional view of the operative field (achieved through the robotics laparoscope located within the patient’s abdominal cavity), and is able to command the robot to perform the tubal reversal through the previously-engaged robotic arms using virtual reality movements, which imitate those used during a standard “open” tubal reversal surgery. Since the robotics instruments can achieve fluid and multiple degrees of motion and articulation which match those of a surgeon’s hands, far superior to the limited maneuverability of standard laparoscopic instruments, the robotics surgeon can complete the tubal reversal in the same manner as the standard “open” technique. Due to enhanced visualization (the operative field may be magnified by 10-fold), stability of the surgical instruments in the robot’s “hands” (shaking is avoided completely), and the ability to achieve exceptionally fine microscopic surgical movements (which is extremely important when handling the delicate tissue of the fallopian tubes), robotically-assisted laparoscopy is ideal for microsurgical tubal reversal (tubal reanastomosis) surgery.
This means superior tubal reversal results with recovery times up to 1/3 to 1/5 those with the standard minilaparotomy tubal reversal, which traditionally requires longer recovery times as a result of a lower abdominal incision which can often reach up to 5-7 cm in length.
Moreover, since the laparoscopic approach involves several small incisions without a larger lower abdominal incision, blood loss and risk of pelvic or wound infection in robotically-assisted laparoscopic tubal reversal is significantly lower than that experienced during a standard “open” tubal reversal. Additionally, in patients with multiple prior cesarean sections and/or those with a high body mass index (BMI=measure of weight status in relation to height; BMI>30=obese range), exteriorization of the uterus and fallopian tubes (raising the uterus and fallopian tubes up through the abdominal incision for adequate visualization) may be quite difficult using the standard “open” tubal reversal procedure, often requiring the surgeon to work on the fallopian tubes while they are “in situ” (deep in the pelvis), making visualization of the tubes somewhat limited.
In contrast, with robotically-assisted laparoscopic tubal reversal the uterus and fallopian tubes remain in their natural location in the pelvis, while the robotic camera and arms are advanced deep into the pelvis for excellent visualization accessibility of the tubes for the reversal procedure; making the patient’s weight and history of prior cesarean sections less important factors in the reanastomosis procedure.