JEREMY PEPPAS

NORTH LITTLE ROCK — Carolyn Underwood needed to see a gynecologist — fast. Her regular physician had found a cyst that needed to be removed.

"I called and got right in," Underwood said.

She didn't bat an eye when Dr. Bryan Fuller, a gynecologist at Baptist Health-North Little Rock, told her that a three-armed robot would help him perform the surgery.

"I had so much pain," Underwood said, "I didn't really care."

The three-armed robot is the da Vinci® Surgical System, and the advantages of the da Vinci system are numerous, according to Fuller.

"The patients have a lot less post-operative pain," he said. "It is a much less invasive procedure. Anytime you have an incision on your abdomen, it's a three- or four-day hospital stay." But that isn't the case with the da Vinci procedure. "It is what we call a 23-hour observation stay. They don't really get admitted to the hospital; we just keep them overnight."

Underwood has family members who have had traditional hysterectomies and was worried about the downtime, missing work and not being able to do normal things.

"I just went grocery shopping," Underwood said six days after the procedure. "I'm good to go now. When we were talking hysterectomy, I was worried, but it hasn't been bad at all."

The reason is simple.

"It is a much less invasive procedure," Fuller said. "The only incision she had was a small one, just big enough to put a pen through."
And not only is recovery quicker, it also means fewer trips to the doctor for follow-ups.

"We don't have to take staples out and bring her back a week later to look at the incision," Fuller said. "We can see her three or four weeks later for just one follow-up and that's it."

So instead of three trips, the patient has one follow-up, and instead of being down for weeks, a post-op patient is back up and going within a few days.

The Machine in Action
The da Vinci system has been in use for urologists and is only slowly becoming popular for hysterectomies, of which over 600,000 were performed in the United States last year.

A big advantage of the da Vinci system is what it allows the gynecologist to see and do while working.

"It has two cameras," Fuller said. "And with the old system, it gave me a two-dimensional view, but with the two cameras, it gives a three-dimensional view, so I can actually see what is going on and I'm able to do finer dissections as a result."

Another advantage is that it gives Fuller an extra arm.

"I'm using the robot to switch between these three arms with instruments on the end," he said. "The instruments articulate, meaning the wrists bend and you are able to operate with two hands, three hands at the same time."

The robotic hands also mimic the movements of Fuller's hands.

"With the da Vinci, if I move my hand forward, the instrument moves forward," he said. "If I move left to right, it follows; it just makes it a lot easier."

The old system was different.

"You had to do the opposite of what your brain was telling you with laparoscopic procedures," Fuller said. "It was like trying to paint a picture by looking in the mirror."

Fuller listed the advantages:

• Remarkably less recovery time.
• Finer dissection capability.
• Harder surgery becomes a great deal easier.
• Less blood loss for the patient.
• Much less post-operative pain.
• Procedure is much less invasive.