When it comes to surgery, small is beautiful. Smaller incisions mean less blood loss, less scarring, and shorter hospital stays. Yet small has not usually been an option for women with cervical and uterine cancers. "For a lot of these women, the only form of therapy is to have a big incision," says Warner K. Huh, M.D., a UAB gynecologic oncologist. "We're talking about an incision that may be 18 inches long" for a conventional hysterectomy. "Typically," he adds, "a patient who undergoes an open hysterectomy remains in the hospital three or four days and doesn't resume normal activity for at least four to five weeks."

But there is an alternative-a futuristic device called the da Vinci surgical robot. Using remotely controlled instruments inserted through tiny incisions, a surgeon can perform hysterectomies and other gynecologic procedures with more accuracy and less trauma to surrounding tissue and blood vessels. The surgeon guides the robot through a control panel, monitoring progress in three dimensions on a screen that offers a better view of the surgical site than traditional laparoscopic surgery.

The surgical site is a fraction of the size of a traditional open hysterectomy, so patients also experience less blood loss and scarring and require less narcotic medication for pain management. "Now, we have patients who leave in less than 24 hours, but we haven't sacrificed the primary goals of their surgery," Dr. Huh says. "Patients actually receive a comparable, if not better, surgery with fewer complications and a faster recovery."

The precision of the da Vinci system also means that laparoscopic surgery is now an option for morbidly obese patients. "I would say that the majority of patients who come to see me right now are at least obese, based on certain parameters," Dr. Huh says. "Five years ago, all of these women had to undergo open surgeries." Recovery times from open surgeries are often lengthened by obesity-related illnesses such as diabetes and hypertension. "Doing it robotically opens doors that we never would have envisioned three to five years ago," says Dr. Huh.

UAB was the first hospital in Alabama to use the da Vinci robot for gynecologic surgery, and it is still one of the few hospitals in the country to do so. But Dr. Huh sees this as the future of treatment. "I think it's going to change markedly the standard of care for women with gynecological malignancies," he says. "There's no question about it."

Caperton Gillett