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Ask Harry: I'm Not a Fan of Robotic Surgery for Endometriosis

Ask Harry: I'm Not a Fan of Robotic Surgery for Endometriosis

Do you have a burning question for EndoFound’s Honorary Medical Director Emeritus and Senior Medical Advisor, Dr. Harry Reich? E-mail him at harry@endofound.org or visit EndoFound’s official Instagram, Facebook or Twitter, tag us and ask a question with the hashtag #askharry, and you could see your answer featured here!

When it comes to the intriguing techniques of endometriosis surgery, Robotic surgery is a very important topic—and perhaps is the easiest to discuss.

In case you're wondering where I stand on the matter: I am not a fan of Robotic surgery

I say that because I've performed over 5,000 gynecologic laparoscopic procedures, and I've been hands-on with each and every one of my patients. Me, my hands and my tools.

No robot arms.

Any patient considering Robotic surgery should understand, before the surgery, that the surgeon cannot feel the disease during the surgery. The surgeon is not even at the operating table. The surgeon depends completely upon sight and previous experience to ablate, or, excise the endometriosis.  It’s like going swimming in a pool and not being able to feel the depth or touch the bottom. 

RELATED: Ask Harry: How Do I Find The Right Endometriosis Doctor?

Patients need to realize that deep, fibrotic endometriosis is a chronic inflammatory response with the laying down of fibrotic scar tissue around the endometriosis glands. A word about that chronic inflammatory response: Endometriosis is the body’s inflammation reaction to the swelling and debris at sites of endometriosis glands. Scar tissue around the endometriosis glands is the result.

It is the same thing that happens after cutting one’s finger. Once the bleeding stops, the area around the wound becomes reddened and swollen, and it hurts.  After one to two weeks, fibrous scar tissue appears in place of the previously cut area. An array of specialized white blood cells known as macrophages rally to our defense. They cart away debris and rally the rest of the immune system to mount a robust response. 

RELATED: Past, Present, and Future of Robotic Surgery for Endometriosis and Hysterectomy

This fibrotic endometriosis tissue can be felt using conventional laparoscopic instruments with the surgeon at the side of the operating table.  It cannot be felt with robotic visualization and surgery.

In laparoscopic excision surgery without a robot, a surgeon can see and feel the scar tissue.  Just the same as a surgeon with a long instrument can see and feel the scar while standing at the patient’s side. 

The same cannot be said for Robotic surgery. 

Expertise in Robotic surgery is much easier to obtain than expertise in laparoscopic surgery without the robot.  This is especially true regarding laparoscopic suturing. 

Some say that the robot acts as training wheels for real laparoscopic surgery.

Beki M., via Facebook, asks: Last surgery, the doctor (an endo specialist, supposedly) said he didn't see new endo, but saw the remnants of endo removal from my surgery the year before. He told me my pain is probably nerve damage. But how can "nerve damage" hurt mostly around my period time and pain flare-ups? He couldn't or wouldn't answer that. So, can nerve damage act like endo pain with the correlated timing of flare-ups? Supposedly there is no endo near that particular area that hurts me ever since I was 13.

Your doctor said he didn’t see any new endometriosis but saw the remnants of new endometriosis removal from his surgery the year before.  This and the continuation of your pain means to me that endometriosis has persisted following his surgery.  Nerve damage is rare with endometriosis surgery unless it involves the nerves, which is very, very rare.  (Endometriosis usually pushes the nerves aside.)  I suspect that your pain is from endometriosis, not from your nerves.

Editor’s note: The opinions, beliefs, and viewpoints expressed by Dr. Harry Reich in this column are solely his own and based on his experience.