Jamal Mourad, DO: Despite the clear advantages of laparoscopic hysterectomy, most surgeons still perform laparotomy as their preferred route for hysterectomy because of the complex skills needed to perform straight-stick laparoscopy. The FDA approved the da Vinci surgical system for gynecologic procedures in 2005. Since then, the number of minimally invasive hysterectomies has increased dramatically.13 The American College of Obstetricians and Gynecologists and AAGL recognize and endorse a minimally invasive approach (vaginal, laparoscopic) to the majority of hysterectomies.14 Despite this recognition, the total number of vaginal and laparoscopic hysterectomies has remained stagnant for the past 25 years. Since the introduction of the robotic platform into our specialty, the total number of laparotomies has decreased significantly, due in large part to acceptance of robotic-assisted procedures.
Arnold P. Advincula, MD: This question—how to advise surgeons—is complicated because it involves so many moving parts. The bottom line: As long as surgeons have the appropriate rationale and indications for its use, proper training with subsequent credentialing and privileging, and the infrastructure to allow for safe and efficient use of the technology with outcomes tracking, then I think the robot is justified for interested clinicians who truly believe it will enhance their performance and care of patients. If some pieces of this equation are missing, then I would caution surgeons about incorporating robotics into their surgical armamentarium. I feel very strongly that many of the issues we see today surrounding robotics are the result of disregarding these very important requirements for the adoption of technology in medicine. We have seen similar issues with transvaginal mesh. Let’s not let history repeat itself in the arena of robotics.
Jamal Mourad, DO: I agree. We need to do what is right. First, do no harm, then do what you would want done to you!
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