Maggie McKay (Host): A woman's body is complex and goes through so many stages from birth to menopause. And within those years, there are several medical procedures that may have to happen. So today, we are so pleased to have with us, Dr. Monica Selander, OB-GYN and gynecologist at Tidelands Health, to tell us more about the benefits of robotic-assisted procedures for women's health.

Host: Welcome to the Better Health Podcast from Tidelands Health. I'm your host, Maggie McKay. Dr. Selander, thank you so much for being here today. Will you tell us a little bit about your role at the hospital?

Dr Monica Selander: Thank you, Maggie. I'm really happy to be here as well. So, yeah, I work as an OB-GYN at Tidelands, meaning I do all types of women's care from adolescent care, managing menstrual cycles and contraception to pregnancies to problems that come up later in life with any type of women's healthcare problems. And I do deliver babies and perform surgeries as well.

Host: Wow. We're extra grateful to have you here because that sounds like a very busy schedule. How long has robotic-assisted technology been around? When was it introduced?

Dr Monica Selander: I believe it was in the early 2000s. Now, I was not practicing at that time. So when I started residency in 2014, it was already in place and in full swing, and that's when I started having my exposure to it.

Host: Medicine with technology has come so far, like robotic-assisted procedures, which is what we're going to talk about today. What are some of the benefits of that for women?

Dr Monica Selander: So, the robotic procedures, it's really a surgical tool to help augment the surgery that the surgeon's actually performing. The da Vinci robot that I utilize, it allows me to operate with enhanced vision, better visuals, having better precision with the actual operation and better control of the instruments. It can take my hand movements that I'm doing into smaller, more precise movements of tiny instruments inside the body, allowing for much more precise movements and operation than our traditional laparoscopy that we used previously.

Host: I saw it once demonstrated and was blown away at how precise it was and how, you know, it could get into places that probably a surgeon's hands maybe couldn't.

Dr Monica Selander: Absolutely. One of the best benefits of those instruments, in addition to there being just a whole slew of different types of instruments to choose from, is that there's an articulating wrist component to it where our other instruments were just straight, they didn't have that type of dexterity and it really mimics your own hand and wrist, allows you to access different angles and different points in the body that'd be pretty challenging when all you have is a traditional straight instrument that we used to use.

Host: Which procedures are the most common for women when you're using robotic-assisted technology?

Dr Monica Selander: The ones that I use it for the most is a hysterectomy. It's also used frequently for myomectomies, when we remove-- we kind of, as a short term, call it a BSO, which is a bilateral salphingo-ophorectomy, which is a fancy word for the ovaries and fallopian tubes being removed, as well as endometriosis resections.

Host: Do patients have a choice between traditional operations and robotic-assisted?

Dr Monica Selander: They do. Everyone has a choice in how things are done. I think most of the time surgeons who are familiar with and comfortable with using the robotic system are going to strongly encourage that choice because that's what they're more comfortable with. And once the benefits of the robotic system are explained to patients, most of the time the choice is going to be the more advanced technology.

Host: What about recovery? Is it quicker? Is there less time in the hospital?

Dr Monica Selander: Yeah. My patients go home from a, you know, straightforward hysterectomy, they'll go home the same day. They actually don't need to stay overnight in the hospital, which is great on many different standpoints they're able to be in the comfort of their own home, being cared for by their family members, which is of course a big improvement from, if you go way back before we had any minimally invasive procedures, when we had to do open incisions, they'd be in the hospital, usually at least a couple of nights. So, this allows them to be home sooner. They're going to feel better sooner.

One of the great aspects of the robotic tools is that there's a point on where the robot actually is kind of coming through the port sites in the abdomen that the robot knows to rotate around that point so that it doesn't move. So when that's in the proper location in the patient's abdominal wall, it reduces a lot of that tugging and pulling that we normally can't help but have with the traditional laparoscopic procedures. So, their incision sites are less painful afterwards. And I've done these procedures where we have mostly robotic port sites, but sometimes have one traditional laparoscopic assistant port. And almost without fail, the patients will complain of pain at that site much more so than the others. So, you know, decreased pain with that. And then, just with any more successful surgery, you're going to have decreased blood loss, decreased risks of complications and problems.

Host: And what about scarring?

Dr Monica Selander: So, scarring is probably similar with this as compared to a laparoscopic procedure. Compared to an open laparotomy, there's more scarring with that. But as you compare to another minimally invasive, patients scar differently just kind of based on their genetics, and they're likely to scar pretty similarly from having the same operation done.

Host: And one thing is that not every hospital offers this technology. So, Tidelands is ahead of the curve, I think, because don't you need specially trained surgeons and also you need to be able to afford the technology?

Dr Monica Selander: Yes. There's a lot that goes into having the system in place. It's definitely a team effort, from the surgeons who are trained in it, like myself, I had this training through residency and was very comfortable with it from that to the operating room staff, who are more able to be trained with how to use the robot, how to clean it, how to assist the surgeon and switch out the instruments, how to troubleshoot when there's things that are going on that are maybe a little bit different than what you usually see. The whole process involves the entire team being comfortable and able to use the technology.

Host: So if one of your patients was asking you, would you always recommend this procedure over the traditional one?

Dr Monica Selander: I would say yes. And what I tell people is it's easy for me to relate to my patients, I think, most of the time because I'm also a female. And if I was going to have a procedure done and the da Vinci robot was an option, I would choose that every time.

Host: Well, it sounds like a lot of wins because less scarring, less blood loss, less risk of infection, because you get out the same day, more precise. That's so interesting about the fact that the da Vinci, for example, is that the only one da Vinci, that their tools are curved?

Dr Monica Selander: I believe so. That's the only one I've ever seen or utilized.

Host: And recovery, quicker. I mean, that's a lot of good reasons, I would think, to have that. So, Dr. Selander, is there anything else that women considering this type of procedure should know that we didn't cover?

Dr Monica Selander: You know, I think it's important to just seek the education when you're seeing your provider, if this is something that they are comfortable with using and recommend to you. Just, you know, ask whatever questions you might have. It's easy to hear the term robot and your mind kind of just will assume what you think about it. You don't know what it is until you maybe see videos on it or ask about it or get information about it. So, education's always power. So, get as much information as you can from your provider and see if it's a fit for you. But I think in most cases, it is going to provide just that higher level of care.

Host: Right. I think that word assisted, robotic-assisted surgery, the assisted word kind of gets thrown out and people just hear robotic, because I've had a lot of people ask me like, "How is it that just the robot can do it?" I go, "No, no. They just help the surgeon."

Dr Monica Selander: Absolutely. That's kind of what I'm implying if you've not told about it, how would you know? I've had people ask me, "Are you in the same room as me when we're having in the surgery?" You know, I mean, that's a good question, because the surgeon console is remote from what's doing the actual operating. And so, that's a reasonable question. So, just to have that explained to you that yes, this technology is assisting me. It only does what I tell it to do. It does my movements. It has no autonomy to do its own thing. It's just a much better, more precise tool to help me do a better operation.

Host: Thank you so much for sharing your expertise. This has been fascinating and very informative, so we really appreciate your time.

Dr Monica Selander: Absolutely. Thank you so much.

Host: Again, that's Dr. Monica Selander. To learn more, please visit tidelandshealth.org. That's tidelandshealth.org. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. This has been the Better Health Podcast, presented by Tidelands Health. Thank you for listening.