Amanda Wilde (Host): Dignity Health Mercy Hospital's S.A. Camp Companies Robotic Surgical Center recently completed over 100 minimally invasive robotic surgical procedures. Those procedures were performed by gynecologic oncologist Dr. Erica Manrriquez. Today, Dr. Manrriquez discusses this surgical milestone and how minimally invasive robotic surgery impacts uterine cancer patients in terms of patient outcomes, recovery time, and overall expectations.

This is Hello Healthy, a Dignity Health podcast. I'm Amanda Wilde. Dr. Manrriquez, thank you so much for being here.

Erica Manrriquez, MD: Hi, thanks for having me.

Host: First of all, let's talk about this surgical milestone you recently achieved, reaching over 100 minimally invasive surgical procedures in the treatment of gynecological cancers, mostly uterine cancers. Why is this surgical milestone beneficial to patients?

Erica Manrriquez, MD: Yeah. We're really excited about this milestone. It's been our goal for the last few years to expand access to the robotics program at Dignity. So now, along with our Colorectal, General Surgery, and Urogynecology teams, Gynecologic-Oncology is proud to be able to offer our patients access to robotic surgery, which is really the standard of care now nationwide.

Host: Well, what are the key advantages of minimally invasive robotic surgery compared to what we think of as traditional surgery for gynecological cancers where you're actually opened up?

Erica Manrriquez, MD: Yeah. So, minimally invasive surgery has made a huge advance over the last couple of decades. Both traditional laparoscopy and robotic surgery are types of minimally invasive surgery, which involves smaller incisions compared to your traditional large or open incision. In appropriately selected patients, we really see a decrease in overall surgical risk when we're able to avoid that larger incision.

We have pretty good data that shows that patients who have minimally invasive surgery have less postoperative pain, fewer complications like bleeding or infection and faster recovery times overall. The vast majority of my patients actually do not need to stay overnight in the hospital. They recover for a couple hours in the post-surgery unit and are able to go home. And so, all of this generally allows a patient to mobilize more quickly, have quicker return of bowel function and get back to work in their sort of daily routine.

Host: So really, it's just less impact overall on your body and a faster recovery.

Erica Manrriquez, MD: Correct. So, less risky overall and much better and shorter recovery time.

Host: Well, how does minimally invasive robotic surgery reduce risk of complications?

Erica Manrriquez, MD: So, compared to traditional laparoscopy, the robot allows the surgeon to see the surgical area in high definition 3D. So, robotic instruments have a much better range of motion. They articulate or move and rotate in a 360-degree motion, more like an actual human wrist. So as a result of that, we're able to do more complex surgical procedures minimally and basically than we would have been able to do with traditional laparoscopy, or open surgery.

So for example, a patient who has extensive scar tissue due to prior surgery or endometriosis, or who has a very large uterus, that traditionally would have needed an open incision to remove, these patients are able to actually undergo surgery with small incisions and really exposes them to that lower risk of bleeding, infection, et cetera.

Host: What are the advances that you have seen in laparoscopic robotic surgery in the past few years?

Erica Manrriquez, MD: Yeah. So, the advances in the last few years are primarily to the robotic platform that we use. So, they actually just came out with the newest version of the robot, which is called the da Vinci system, the da Vinci 5. But we've been on the da Vinci four now for the last several years, which was a massive improvement compared to the prior model, which is what I trained on in residency and really just allowed for a closer mimic to human movement, so to what my hand or wrist would be doing if I actually had my hand or wrist in the body as like I do in open surgery, which is really, again, the basis for what allows us to do so much not robotically compared to what we could do with traditional laparoscopy, which you can liken to almost using more chopsticks to complete the procedure.

Host: Do you expect more advances with robotics in the future?

Erica Manrriquez, MD: I'm sure. Honestly, this is not my area of expertise per se. There's a whole community within Gynecology and Gynecologic-Oncology who is actively studying all of this, but I fully expect AI to have a role in all surgery, but robotic surgery as well as we move into the future. But there's a lot of sort of little things about visualization and ability to move and manipulate tissue within the body while I'm not at the bedside, I'm sure, will continue to advance over the next five, 10, 20, 40 years.

Host: It's already amazing compared to what we traditionally think of as surgery, which is cutting open with knives, and now that seems so primitive in comparison. But back to the present, what expectations should cancer patients have if they are preparing to undergo minimally invasive surgery for their gynecological cancer treatment?

Erica Manrriquez, MD: Yeah. Great question. So, I do remind patients that a hysterectomy, for example, is still major surgery. So even though they may come out of their robotic hysterectomy with small incisions, they still have undergone major surgery internally, which requires a certain level of rest, activity restrictions, and time, you know, to heal. So while they may heal much better much faster than a large open incision, their body has still undergone a big metabolic event, and it will take time for them to feel back to their normal.

Host: Now, September is Gynecological Awareness Month, but for you, it's year round. What do you want your patients to know about their gynecological health?

Erica Manrriquez, MD: Yeah. A reminder I always try to insert everywhere is to do not disregard irregular bleeding. So if you're still having periods and they suddenly become much heavier or you start to bleed twice a month or between periods, that's not normal. You need to talk to your doctor. Or, you know, if you've already gone through menopause and have stopped having periods, but start having bleeding again, even if it's just spotting on the toilet paper, that is also not normal, so you should call your doctor and get in for an evaluation. Take that seriously.

Host: Abnormal bleeding is probably the biggest sign that something is not right, correct?

Erica Manrriquez, MD: Exactly. Yeah. So, it doesn't always mean there's a cancer diagnosis. There's plenty of non-cancerous reasons to have irregular bleeding, but one of the reasons that uterine cancer specifically is generally able to be cured so frequently is that we catch it early because it shows up as a regular or postmenopausal bleeding. So, take that seriously. It doesn't mean you have cancer, but it should be evaluated.

Host: If patients do want to learn more about accessing minimally invasive robotic surgery for uterine or other gynecological cancers, where should they go?

Erica Manrriquez, MD: So, there are a few resources online that they can look for. Intuitive, which is the company that brings us the robotic platform has a nice section on robotic gynecologic surgery. They can just Google gynecology, robotic-assisted surgery Intuitive. Intuitive also has an area on their website where you can actually search surgeons that are local to you that are da Vinci surgeons or robotic surgeons. So, you type in your ZIP code in the surgeon locator. It can help you find someone who may be able to offer you or assess you for candidacy for robotic procedure. And kind of on a related note, you can also click on the actual procedure that you're interested in and learn more about it and surgeons that may be able to offer it to you.

Host: Well doctor, thank you so much for this hopeful information about robotic surgery for gynecological cancers. And congratulations on the surgical milestone you've reached of over a hundred minimally invasive robotic surgical procedures.

Erica Manrriquez, MD: Thank you so much for having me. Appreciate it.

Host: That was gynecologic oncologist Dr. Erica Manrriquez. Learn more at dignityhealth.org/bakersfield/womenscenter. And if you found this podcast helpful, please share it on your social media and check out the entire podcast library for other topics of interest to you. This is Hello Healthy, a Dignity Health podcast. Thanks for listening.