Robotic-assisted surgery: Advancing surgical care and outcomes for our patients


Photo courtesy of Allen Kramer (Texas Children's Pavilion for Women)

As Division Chief of Minimally Invasive Gynecologic Surgery at Texas Children’s Pavilion for Women®, I frequently see patients with complex surgical needs. Thanks to amazing advances in robotic single-site technology and traditional single-site and transvaginal Natural Orifice Endoscopy Surgery (NOTES) for advanced pelvic surgery, many conditions – like endometriosis, uterine fibroids, pelvic prolapse, hysterectomies and reproductive cancers – can be performed using minimally invasive techniques.

It’s amazing how far we’ve come in advancing surgical care for our patients. As an accredited Center of Excellence in Minimally Invasive Gynecology, our surgical team at the Pavilion for Women has completed more than 500 robotic procedures. Of these cases, nearly 230 have been performed using our new Da Vinci Xi Surgical Robot System. Using this technology has expanded our surgeons’ capabilities to perform minimally invasive procedures for some of the most complex cases.

I perform mostly single-incision and NOTES surgeries to treat gynecologic conditions. Robotic-assisted surgery is very fascinating for many reasons. First and foremost, this technology helps my colleagues and I perform surgeries in a minimally-invasive way that benefits both our surgeons and our patients. In place of certain open procedures, where surgeons had to make large incisions that were 4 to 8 inches long, the robotic technique offers greater precision and allows surgeons to make a single, curved incision – only 1.5 to 2.5 mm – via the belly button to operate on parts of the female reproductive system.

Once a patient is prepped for surgery in the operating room, the surgeon sits at a nearby console that is connected to the robot’s magnified 3D high-definition vision system. The console provides 3D images of the surgical site and enables surgeons to control the arms of the robotic instruments. The tiny arms of the robot can rotate 360-degrees, which provides our surgeons with a wider range of motion and flexibility compared to standard minimally invasive laparoscopic procedures. In addition, the robot’s special wristed instruments bend and rotate far greater than the human wrist, yet the surgeon is in complete control.

While this novel approach benefits surgeons, robotic surgery also has benefits for our patients, including shorter hospital stays, faster recovery and reduced pain and scarring. As a surgeon and pioneer in single-site and NOTES surgery, one aspect I find most fulfilling about my job is hearing patient testimonials of how their quality of life has improved tremendously after their surgery. One particular patient who comes to mind is Ashley Nance. Before Ashley came to me for surgical care in March 2019, her endometriosis had spread to her bladder, bowel and other internal organs.

“I had painful symptoms of endometriosis long before my official diagnosis in 2013,” Ashley said. “Before I met Dr. Guan, I had six unsuccessful robotic surgeries. Unlike Dr. Guan’s treatment approach – full excision surgery to treat endometriosis – my surgeons, at the time, performed multiple ablation procedures. I learned this method wasn’t as effective compared to full excision. With ablation, there was a greater chance the endometriosis could grow back again, which it did. My former surgeons took a more conservative approach and didn’t feel it was necessary to excise all of the diseased tissue.”

Because Ashley’s case was very complex, I performed two robotic procedures – one in March 2019 and the other in Sept. 2020 – where we removed all traces of endometriosis disease from the affected areas. Since Ashley had a very severe form of endometriosis that spread to her bowel and bladder, I enlisted the expertise of our multidisciplinary team, including a general and colorectal surgeon, to operate with me. This collaboration ensured we removed all signs of disease, leading to the best possible outcome for the patient.

“My 6-hour operation with Dr. Guan literally changed my life,” Ashley said. “I feel like a new person again. I am so glad I found Dr. Guan thanks to a local endometriosis support group. They recommended him and spoke very highly of the Pavilion for Women’s robotic surgery program. After my surgery, I spent two days in the hospital. A few weeks later, I was back on my feet. My recovery time was shorter and less painful compared to my C-section. Dr. Guan’s treatment plan for me was spot on. He was the only surgeon who not only treated my symptoms, but the disease itself, which greatly improved my outcome. I am grateful to Dr. Guan and his team. I can finally live my life again and be a mom to my 4-year-old daughter.”

Texas Children’s Pavilion for Women has achieved accreditation as a Center of Excellence in Minimally Invasive Gynecology. Click here to learn more about the Pavilion for Women, and the latest minimally invasive robotic surgeries available for the treatment of common and complex gynecologic conditions.