Robotic Surgery

Using the da Vinci System, doctors operate through a few small incisions in your abdomen or through the bellybutton instead of a large open incision. It is similar to traditional laparoscopy except the da Vinci System gives doctors a three-dimensional, high-definition view inside your body. It also features surgical instruments that bend and rotate far greater than the human wrist. The doctor is always in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movement of tiny instruments inside your body.

Why Robotic-Assisted Surgery?
There are certain procedures that require enhanced visualization, a high-definition, 3-dimensional view of pelvic anatomy, and better precision and control. Sometimes there are certain patient characteristics or details of their medical and surgical history that would make this option more desirable.

Expertise and skill are two of the most fundamental criteria a patient should desire when choosing a gynecologic surgeon. The daVinci robot is a surgical instrument that can not compensate for, or improve, surgical training. Fortunately for her patients, Dr. Rebeles is extensively trained in both traditional laparoscopic surgery and robotic-assisted surgery.

Dr. Rebeles will thoroughly evaluate each patient’s medical history to decide if robotic-assisted daVinci surgery is the best route for surgery.
Robotic-Assisted Hysterectomy
Using the daVinci Si Robotic System Dr. Rebeles is able to remove all or part of the uterus in a minimally invasive fashion. Dr. Rebeles prefers to perform hysterectomy with the assistance of the robot in patients who have complicated medical histories, patients with prior surgeries or where surgery is anticipated to be challenging because of a patient’s anatomy. Proper recognition and understanding of surgical anatomy is paramount to successful and safe completion of any surgery.
Robotic-Assisted Myomectomy
Minimally invasive management of fibroids is one of the more challenging procedures in gynecology because of the difficulties encountered when removing fibroids. Because the uterus is being preserved, blood loss can be substantial. Also, it is important for your doctor to perform a multi-layered closure of the uterus where the fibroids are removed. In certain cases, these challenges may be overcome with the assistance of the daVinci Si Robotic System.
Robotic-Assisted Removal of Endometriosis
Recently, the robot was theorized to aid in the management of endometriosis by allowing the operator to see more endometriosis. The assistance of the robot is being used by an increasing number of surgeons worldwide to treat endometriosis. This minimally invasive approach, utilizing the latest in surgical and robotics technologies, is ideal for delicate gynecological surgeries. It allows your surgeon to perform a thorough removal of deeply penetrated or widespread endometrial implants – while preserving your uterus.

Dr. Rebeles is a highly trained specialist in robotic surgery, including the use of the da Vinci robot for endometriosis. She is also trained in the use of Firefly Flourescence Imaging, which utilizes Indocyanine Green (ICG) dye which enables surgeons to perform minimally invasive surgery using standard endoscopic visible light as well as visual assessment of vessels, blood flow and related tissue perfusion. Though in its early stages for use in gynecologic surgery, Firefly can potentially provide more accurate visual diagnosis of endometriosis during a da Vinci robotically-guided endometriosis resection procedure.

Firefly Flourescence Imaging
Robotic-Assisted Ovarian Cystectomy
When scarring from previous surgery (such as a previous hysterectomy), or other complicating factors are anticipated, the da Vinci robotic system is often employed. Also, in cases where the cyst is very large or careful dissection is needed to avoid spillage of contents within the cyst, the robotic approach can help accomplish ovarian cystectomy with better precision. Most patients can go home the same day as the surgery.
Robotic Uterosacral Ligament Suspension
The robotic-assisted approach to a vaginal suspension procedure such as a uterosacral ligament suspension allows for better surgical precision, including increased visualization and a high-definition, 3-dimensional view of pelvic anatomy. The uterosacral ligaments lie in close proximity to the ureters, the tubes that drain urine from the kidney to the bladder. Dr. Rebeles is able to perform a more thorough dissection of the pelvis to avoid injury to key structures using the robotic approach. She is also able to better define the ligaments readily and also identify key anatomic structures for a sound suspension of the vagina.
Robotic-Assisted Sacrocolpopexy
Abdominal sacrocolpopexy (SCP) is recognized as an excellent repair for advanced prolapse of the top part (apex) of the vagina, with demonstrated long-term success. Because of the longer recovery with an open (abdominal) procedure, the minimally invasive approach is preferred. Dr. Rebeles has extensive training performing sacrocolpopexy with the assistance of the robot for prolapse repair. The use of the daVinci Robotic System is employed for better surgical precision, including increased visualization and a high-definition, 3-dimensional view of pelvic anatomy. With this particular procedure, the robotic approach allows for ease of suturing graft material to the vagina, which provides for excellent long term results.
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