UAMS Is First in Arkansas With Robotic Procedure
| LITTLE ROCK – Alexander “Sandy” Burnett, M.D., at the Burnett, a gynecologic oncologist, performed the robotic radical trachelectomy April 28 using UAMS’ recently acquired da Vinci surgical robot. Ideally, the procedure would have been done through the vagina, which is the least invasive method and would give the patient the best chance of becoming pregnant someday. But the 25-year-old patient had never had children, which meant her cervix was too difficult to reach for a vaginal procedure. By using the robot, which provides dexterity far beyond other surgical methods, Burnett was able to use small incisions to go through the abdomen without damaging reproductive organs while removing the cancerous cervix. “The robot changes everything,” said Burnett, chief of the Division of Gynecologic Oncology in the UAMS Winthrop P. Rockefeller Cancer Institute. “Instead of having fixed jaws, the instruments can be moved any way your wrist can move.” Following the procedure, the patient was discharged after an overnight hospital stay and her prognosis is good; her cancer was in its early stages and her pelvic lymph nodes tested negative for cancer. She will return for exams at the end of June and the end of August. Her August visit will determine if there’s been any recurrence of cancer. If not, she will be cleared to have children if she wishes. Traditionally, women with cervical cancer have been treated with radical hysterectomies that remove all their reproductive organs. Only in the last decade have surgeons such as Burnett performed radical trachelectomies, which leave the uterus, or womb, intact. Burnett has performed radical trachelectomies since 1995 by going through the vagina and with an open surgical approach through the abdomen. Until Burnett’s breakthrough robotic surgery, open abdominal surgeries have been the only option for women whose cervix could not be reached through the vagina. The problem with going through the abdomen is that patients have had poor pregnancy rates following the procedure. Doctors believe decreased fertility after an abdominal radical trachelectomy is unavoidable due to the nature of the surgery. For instance, to prevent bleeding, the surgery requires that the uterine arteries be tied off, Burnett said. “One of the theories for the decrease in infertility is that by taking that blood supply you diminish the capacity to keep a fertilized embryo in the uterus,” he said. “Another theory is that the abdominal approach leads to adhesions, which can interfere with a woman getting pregnant.” Burnett realized the robot could become the answer to both of those problems, and after studying possible approaches and consulting with other surgeons experienced in radical trachelectomies, he designed a procedure using the robot. “I’ve thought about this for a long time, and I was very excited that it just really came together exactly as I imagined it,” Burnett said. “I think it’s a procedure that will catch on.” During the robotic procedure, Burnett was able to make small incisions in the abdomen for a miniature camera that provides a 3-D view and tiny surgical instruments that Burnett could easily maneuver without damaging reproductive organs and blood vessels. The robot has four arms, which the surgeon manipulates at a console just a few feet away. “After radical vaginal trachelectomies, virtually all of my patients have been able to have children,” Burnett said. “I believe the success rate with the robot is going to be just as good. There’s no reason to think it won’t be.” UAMS is the state’s only comprehensive academic health center, with five colleges, a graduate school, a medical center, six centers of excellence and a statewide network of regional centers. UAMS has 2,538 students and 733 medical residents. Its centers of excellence include the Winthrop P. Rockefeller Cancer Institute, the Jackson T. Stephens Spine & Neurosciences Institute, the Myeloma Institute for Research and Therapy, the