Gynecologic Oncologist Uses "Small Cut, Big View" Robotic Surgery
"Don't try to do too much too soon," yelled out Howard M. Saul, D.O., to the 49-year-old patient who had just bounded out of his office like a teenager. "You just had major surgery."
"I'll try," she shouted back from the hallway. "But when you feel this good it's hard to remember it was major surgery."
Dr. Saul (pictured at right), who 10 days earlier had removed grapefruit-sized ovaries from the woman (read her story here), shook his head and marveled at the technology that had just saved the patient many weeks of painful recovery. The key: the daVinci® Robotic Surgery System.
The gynecologic surgeon recalled the first time he looked at the three-dimensional view of internal organs made possible by three robot arms and a camera inserted into small incisions in the patient's abdomen. He's a 20-year veteran of surgery who doesn't use superlatives casually. But he used superlatives.
"It was unbelievable. Amazing ," he said. "It was the same sense of wonder as when I put on my glasses for the very first time. Definitely a 'wow' experience."
The daVinci® system at Our Lady of Lourdes Medical Center allowed Dr. Saul to remove the pain-causing ovaries without the large incision required by traditional open surgery. The small-incision robotic surgery carries less risk of blood loss, less pain and scarring, and, in this patient's case, drastically pared the six to eight week recovery time associated with open surgery. In short, the less-invasive robotic system produces dramatic success stories.
In less than a year, Dr. Saul has so embraced the robotic device that he now has the greatest experience in South Jersey in the use of daVinci® surgery for gynecologic oncology surgery.
"Your vision with the daVinci® system is even better than in open surgery," said Dr. Saul. He held his hand several feet below his eyes and said: "Look, in regular surgery the organ is down here where my hands are, but my eyes are up here because I can't put my head inside the incision.
"With daVinci® I am looking at a screen that gets me within inches of the organ, where I can see everything better and be more precise. I can get to the little blood vessels without getting this in the way," he said, pointing to his head with a laugh.
The other major daVinci® advantage, he said, is the "wristed" movement of the small robot arms that duplicate on a smaller scale all of the movements made by the surgeon's hands inside the sophisticated glove-like devices below the 3-D monitor.
He beckoned his visitor to the screen of his laptop computer to play a short video showing the daVinci® instrument "hands" folding a small square of paper into an origami sculpture—a paper bird. The finished sculpture was smaller than a penny.
"The daVinci® system really is the next evolution of laparoscopic surgery, which was a milestone because it was minimally invasive," said Dr. Saul. "This takes it to a whole other level."
While open surgery and conventional laparoscopic surgery remain as viable options in many cases, there are times that the robotic system has major advantages. It works well when the patient has many adhesions from prior surgery. And he recently had performed daVinci® surgery on a patient weighing nearly 300 pounds.
"If that was done through a regular massive cut, that patient would have taken months to heal and faced a really difficult post-operative course," he said. "Traditional surgery in an obese person is very problematic because they are at risk for a lot of complications and the daVinci® system decreases the risks.
"I operated on a patient who had an artificial valve and needed to be on an anticoagulant. A traditional big cut in the belly would have been very problematic. We did daVinci® and and she did great."
Of course, the robotic machine does not "do" the surgery and the skill of the surgeon is crucial, he said. But the machine does provide more physical comfort and less anatomical stress for the physician in the OR, he said.
"And outcomes have been superior because of machine, no question about it," he said. "It's because of the technology advances it offers us. It's another tool."
Dr. Saul, who helped found the gynecologic surgery program at Our Lady of Lourdes Medical Center, can be reached at 856-673-0015.