The Advantages of Gynecologic Robotic Surgery with Jennifer Patchett, M.D.

In this episode of Advance with MUSC Health, Jennifer Patchett, M.D., an obstetrician/gynecologist at Florence Women’s Pavilion, discusses how the robotic da Vinci Surgical System allows her to provide minimally invasive gynecological surgeries to patients. In addition to sharing her journey in OB/GYN surgery, Dr. Patchett discusses how she determines if surgery is the best option for a patient, how the robotic da Vinci Surgical System optimizes medical procedures, and the benefits that robotic-assisted surgeries provide both doctors and patients.

“Standard of care is becoming robotic surgery and so most residency programs are absolutely training their OB/GYNs to perform robotic surgery. The technology is so fantastic. The patient outcomes are so good. The capabilities of it are so extensive that it's necessary.”
— Jennifer Patchett, M.D.

Topics Covered in This Show

•  The robotic da Vinci Surgical System has two cameras which provide both 3D vision and enhanced magnification while operating.
• Firefly is one feature of the robot that Patchett describes as giving her “night vision” during surgery. When using the Firefly feature, a dye is injected into the ureters, making them glow. This is so that surgeons can clearly avoid the ureters during surgery and minimize the risk of damaging them as well as the bladder.
• Before robotic surgery was available, patients would often spend multiple nights in the hospital and often require several weeks of recovery. However, with robotic surgery, patients are often able to go home the same day and often have pain that only lasts for a few days.
• Patchett has performed 74 surgical cases and 56 hysterectomies in the year and a half she has been using the robotic surgical system.
• Robotic technology used by Patchett and her colleagues can aid in: the removal of one or both ovaries, the removal of large cysts on the ovaries or fibroids from the uterus, and the removal of the uterus in the case of a hysterectomy. It can also assist in the surgical treatment of uterine ovarian cancers.
• In the case of a hysterectomy, the Fallopian tubes are typically removed as well, as they're no longer useful and can relieve a patient of the excessive bleeding.
• If women who are under 50 have ovaries that are normal and healthy, Patchett will leave them so they will not go through early menopause.
• Robotic surgery opens the door for more patients to be candidates for surgery.
• Patchett and her colleagues at MUSC Health train all surgical staff, nurses, scrub techs, and anesthesiologists to be very comfortable using the robot.
• While some patients may have reservations about robotic surgery, it’s important to keep in mind that the robot is not doing the surgery itself, but is a tool fully controlled by Patchett and her colleagues.
• Robots like the da Vinci system have relieved doctors of the physical strain on their shoulders, neck and back which typically resulted from standard laparoscopy and open surgery procedures.

Read the Transcript

[00:00:00] Erin Spain, MS: Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Robotic-assisted surgery is taking place across MUSC Health to treat a variety of conditions, including many complex gynecologic conditions. At MUSC Health Florence Women's Pavilion, Dr. Jennifer Patchett is using the da Vinci Robotic Surgical System to offer minimally invasive gynecologic surgery to her patients. She joins me today to talk about the advantages of this type of surgery and what makes someone a good candidate for robotic gynecological surgery. Welcome to the show.

[00:00:49] Jennifer Patchett, M.D.: Thank you.

[00:00:49] Erin Spain, MS: Well, tell me a little bit about you. What drew you to OB/GYN and focusing specifically on surgery?

[00:00:56] Jennifer Patchett, M.D.: I love the specialty. You get to follow women throughout their whole life. So from when they start having periods as teenagers, through having babies, then through menopause. And, a lot of women will end up with problems with their periods, especially once they hit late 30s, early 40s, we'll start seeing a lot of heavy menstrual bleeding, things like that and so we end up having to do, you know, a lot of interventions and treatments because it is so hard on life to have terrible bleeding when you're busy with family and everything else. And so, it's really fun to operate and to fix people and have their lives so much better afterwards, and it's just fun.

[00:01:39] Erin Spain, MS: Tell me a little bit about your goals of care and how you approach each patient who comes to you when they are seeking a surgical treatment, and you think it might be the right solution for them.

[00:01:50] Jennifer Patchett, M.D.: One of my big things is patient education and so we go through all of the treatment options starting with medical management, hormonal therapy, IUDs, ablations, kind of everything and then the big surgical hysterectomy. So the hysterectomy is the removal of the uterus and cervix, and we typically take the Fallopian tubes as well because they're not useful anymore once you have a uterus gone. And that takes care of the bleeding. But in women who are under 50, a lot of times we don't take the ovaries. If their ovaries look normal and healthy, we'll leave those and then they don't go through early menopause. Surgical hysterectomy, that's your ultimate treatment for bleeding and fibroids and things like that. But every patient's different. Every patient has different goals and it's really important to kind of establish with them what the best treatment option for them is because it's not a hysterectomy for everybody, but it's a great option for women that need it.

[00:02:48] Erin Spain, MS: And today we're talking about the robotic da Vinci surgical system. Now, this robot assists you during surgery with really incredible power. For example, it can see 10 times what the human eye can see during surgery. Explain this technology to me and the many ways it's a game changer for you and your patients who do need surgery.

[00:03:07] Jennifer Patchett, M.D.: Yeah, the visualization with the robot is so much better even than standard laparoscopy. It actually has two cameras, so each eye has its own camera, so it gives the surgeon 3D vision, which is just incredible. And the magnification is so significant. It's really easy to distinguish between different tissue types and to take down scar tissue, and to really find the correct plane and make sure you're not damaging anything. There's also a really cool feature of the robot that I use a lot called Firefly. It's essentially like night vision, and so one of the things I do before the case is I inject a dye into the ureters. The ureters are the tube that connect the kidneys to the bladder and it runs right by where we're operating to do a hysterectomy. I can flip on Firefly and they glow green and I can tell exactly where they are and make sure that I stay well away from them, because that's one of the biggest risks with hysterectomy is damage to bladder or ureters. The fact is with the robot, I can see them exactly where they are and there's no mystery.

[00:04:12] Erin Spain, MS: How is this different than when you first started doing hysterectomies? Take me back to earlier on in your training. Were you doing open surgery?

[00:04:20] Jennifer Patchett, M.D.: Oh, definitely. We would do some vaginal hysterectomies, some laparoscopic hysterectomies if they were pretty small uteruses, anything that was any kind of a decent size. If it had big fibroids on it, they got an open procedure.

[00:04:33] Erin Spain, MS: And what was that like for you as a surgeon and for the patient, the recovery, the experience?

[00:04:38] Jennifer Patchett, M.D.: It's a big procedure. You're spending two nights in the hospital. You have a full six week recovery time. It's a big deal and so you kind of had to plan your life around, "OK, I'm having major surgery." And it's also physically taxing on the surgeon to operate like that, which is one of the really interesting things about the robot is the ergonomics to the surgeon and the decrease of strain on the surgeon themselves. I can do way more surgeries and way more often without my body hurting at the end of the day.

[00:05:10] Erin Spain, MS: That's amazing for you and the longevity that it gives you, right? And the ability to do more, but for the patients as well. Tell me about the difference in recovery, from the open surgeries that you used to do, to the robotic assisted surgeries that you do mostly now.

[00:05:25] Jennifer Patchett, M.D.: Sure, with the robot, they go home same day. It is literally an outpatient surgery. They come in, they have surgery, they go home that afternoon. Pain for a couple of days, maybe a week. If they don't have super strenuous jobs, I'll actually send them back to work at one to two weeks post-op, so it's a significant difference.

[00:05:42] Erin Spain, MS: Yeah. I mean, and you mentioned before, these are women who at this age, when a lot of women have hysterectomies, they are busy. There's a lot going on in life. What's it like to be able to sort of give that freedom to your patients to have this surgical procedure that's really going to help them and they don't have to put their lives on pause for such a long time.

[00:06:01] Jennifer Patchett, M.D.: It's a huge game changer because again, the women that primarily are getting hysterectomies are women in their 40s. They have young kids with active schedules and husbands who are busy, and there's a lot going on for women in their 40s, and to not be down for six weeks is a huge deal.
[00:06:17] Erin Spain, MS: Tell me about your experience so far with this robotic system. How many procedures have you done, specifically hysterectomies?

[00:06:24] Jennifer Patchett, M.D.: So I just pulled it up and looked. We actually have an app and it tracks our surgical time and how many cases we do and the types of cases and which instruments we used. It's amazing technology. I have done 74 cases and 56 hysterectomies in the year and a half I've been doing it.

[00:06:40] Erin Spain, MS: You mentioned before the sort of uncontrollable bleeding that a lot of women experience, especially as they're going through menopause. Explain to me how the hysterectomy really takes care of some of these symptoms. So first of all, like, what symptoms is it taking care of and how does the surgery take care of it?

[00:06:55] Jennifer Patchett, M.D.: Sure. So, lots of different causes of abnormal uterine bleeding. Fibroids is a huge cause. Fibroids are problematic because they don't lend themselves well to other forms of treatment, like IUDs and ablations don't work as well if you have a big fibroid uterus. Just structurally, it's a problem. But a lot of women just have abnormal bleeding because they're no longer ovulating every month and so they're not having nice cyclic periods like they used to and now they can just have two periods a month or just bleed for three weeks straight, and that's definitely terrible on your life to just be constantly bleeding. And a lot of women will start having a lot of pain with periods at that point too. They're passing big clots, their uterus is big, it's cramping more, which causes issues. And so now we can offer really great treatments for that.

[00:07:46] Erin Spain, MS: So, across MUSC Health, many of your colleagues are using the robot for different gynecological surgical conditions. Explain some of those to me. Is it being used for gynecological cancer, or you mentioned endometriosis, fibroids? Tell me about some of the different conditions that it can help.

[00:08:03] Jennifer Patchett, M.D.: So we'll use it for taking down big cysts on ovaries or removing ovaries, sometimes if we're not doing a full hysterectomy. It has multiple arms with different wristed instruments, which allow us to open up an ovary and take the cyst wall out, which is really difficult to do laparoscopically, but with the robot, it's much easier. We're able to really cauterize and kind of control bleeding and save the ovary if that's kind of our goal. We're trying to take a cyst off and keep the ovary. And then, the robot is super useful for oncology for uterine ovarian cancers. Our colleagues out of Charleston actually have offices here and have started doing some procedures here, as specifically robotic procedures that they can do as an outpatient and send patients home same day. That's something that we've actually just started here in Florence is our gynecology surgeons are using the robot to treat cancer.

[00:08:56] Erin Spain, MS: Now, are there some people who may not be a candidate for robotic surgery, or does robotic surgery really open the door to allow more people to be candidates for surgery?

[00:09:07] Jennifer Patchett, M.D.: It definitely opens the door. So the length of the instruments is significantly better. So, whereas weight and BMI was a little bit of an issue trying to do a laparoscopic before, and it's definitely an issue if you're trying to do an open procedure, we're able to handle that much easier with the robot. It almost makes no difference in terms of patient weight and BMI, which is nice. The previous C-section number is sometimes problematic because the bladder can scar down to the uterus. With the robot, it's much easier and the visualization is so much better. It's such a safer procedure for those kind of patients. And then the other really interesting thing about the robot is the camera and the instruments are all angled, which allows us to see around corners, so I can do significantly larger uteruses, so big fibroid uteruses that previously would have had to have been open I'm able to do with the robot now.

[00:10:03] Erin Spain, MS: So it really is a game changer in many ways, and you've only had this technology for a year and a half. What do you expect in the future? What do you think we could see as this technology progresses?

[00:10:14] Jennifer Patchett, M.D.: I mean, our goal is to almost never have to open a patient to do a hysterectomy. The goal would be to be able to do every single one of them with the robot. That's kind of where we're on target for.

[00:10:25] Erin Spain, MS: To get all my colleagues, all my fellow surgeons trained as well . Three of us are using it currently. Our new partner who starts next month actually is already trained. We're training one right now. So, we're on board to be able to offer this to lots and lots of women in the area.

MUSC Health here in South Carolina really gets a lot of complex cases from the region, and they come to MUSC Health seeking out this specific type of surgery. Tell me why MUSC Health is situated so well to handle the more complex cases out there.

[00:10:58] Jennifer Patchett, M.D.: It's a really well designed program. We worked really hard to make sure that all of our surgical staff, nurses, scrub techs, anesthesia were all very comfortable with the robot and could all use the robot. So it didn't matter who was scheduled that day.

If we have a patient who comes in who needs a robotic surgery, we can do it. Urology and especially our general surgery colleagues are using this a lot, and one of the things that our hospital offers is 24/7 access to the robot. So patients who come in who need a gallbladder done in the middle of the night, who have a perforated ulcer, I mean all kinds of things come in the middle of the night, our staff can handle it and we can use the robot. We use it for ruptured ectopics. If I have a ruptured ectopic pregnancy and a belly full of blood, I can use the robot and get really, really great results in the middle of the night and that's something that other hospitals don't offer.

[00:11:54] Erin Spain, MS: There's also the element of research and training the next generation of physicians and surgeons. That's something that's part of the mission of MUSC Health. Tell me about this next generation and some of the training that's happening for them as residents and fellows come through.

[00:12:08] Jennifer Patchett, M.D.: Standard of care is becoming robotic surgery and so most residency programs are absolutely training their OB/GYNs to perform robotic surgery. The technology is so fantastic. The patient outcomes are so good. The capabilities of it are so extensive that it's necessary. It's part of every residency training program now.

[00:12:30] Erin Spain, MS: Talking directly to patients, especially those maybe when they were younger, their mom had a hysterectomy, or an aunt, and they remember what that was like. And this is something that might be in their future down the road and they're hearing this for the first time maybe, that it's different now. The recovery is different. The procedure is different. What would you like to say to those patients who are just sort of discovering that this is a very different surgery than their mother or grandmother's surgery?

[00:12:55] Jennifer Patchett, M.D.: I have a lot of women, more who are scared. We mention, "Oh, OK, I'll do a robotic hysterectomy on you." And they're like, "No, no, no, no, no. I don't want a robot operating on me." We have to go through and explain, it's actually not a robot. I'm doing the surgery, I'm sitting at the console and controlling the instruments. The instruments are just attached to a machine. And so it's like I'm using a video game controller, but way more technical, to control the instruments that are in the patient. But it is not a machine doing the surgery, I'm doing the surgery. And so the term robot is definitely sometimes can cause some misconceptions. Again, it's talk to your surgeon and discuss, is a hysterectomy the right treatment option for you? And again, yeah, the recovery time is so much better, it's a game changer.

[00:13:44] Erin Spain, MS: Do people ever ask to see the machine itself before they go into surgery? Is there some curiosity there?

[00:13:49] Jennifer Patchett, M.D.: Sure. Yes. And so sometimes I'll pull up pictures on my phone and show them. I'm like, "OK, so this is what it looks like. Here's the surgeon console. Here's the part that holds the instruments that's over top of the patient. I put the trocars in and then we insert the instruments and then I sit down and control them."

[00:14:04] Erin Spain, MS: You mentioned before how much wear and tear there was on your body as a surgeon doing these open procedures. Explain to me your future now as a surgeon. Do you see this extending your ability to continue doing surgery well into the future.

[00:14:19] Jennifer Patchett, M.D.: Absolutely. I will be able to continue doing the surgery until I retire. I used to have to get massages every other week because I would have such terrible neck, shoulder, and back pain from doing standard laparoscopy and open procedures.

[00:14:33] Erin Spain, MS: What's it like for you to see this sort of come full circle now where patients are able to recover quicker, get back to life sooner, without as many complications. What's that like for you as a surgeon to see that?

[00:14:48] Jennifer Patchett, M.D.: It's fantastic. For a lot of women, the hysterectomy really is the best option and now it's not this huge ordeal that has to be undertaken in order to get the treatment that they need. We're not settling for halfway measures that really aren't controlling symptoms for them and really aren't fixing their problem when what they really needed was a surgery, but they couldn't take the time or, you know, work it into their schedule, or take the time off work. I mean, there's so many reasons women didn't want to commit to a big surgery, but now it's not quite so daunting.

[00:15:21] Erin Spain, MS: What do you do to optimize your health and live well?

[00:15:25] Jennifer Patchett, M.D.: So I am a runner, so exercise is a big deal. I actually coach cross country for the city's youth program in the fall. And, then I think mental health is huge too, like spending time with my family, going to church, all of that just factors into a nice, healthy lifestyle.

[00:15:44] Erin Spain, MS: Thank you so much for coming on the show today and explaining what you do and really this game changing procedure for a lot of women. I appreciate it.

[00:15:52] Jennifer Patchett, M.D.: You're welcome. Thank you.

[00:15:53] Erin Spain, MS: For more information on this podcast, check out Advance MUSC Health.org.