Dr. Gargiulo demonstrates his robotic technique to an audience of more than 1,000 surgeons.

Dr. Antonio Gargiulo, Medical Director of Robotic Surgery at the Brigham and Women’s Hospital (BWH), has performed hundreds of computer-assisted laparoscopic surgeries, but the one he performed on October 22, 2012, was very special.

The surgery, a robotic myomectomy to remove a uterine fibroid tumor in a 29-year-old patient, was beamed live from Brigham and Women’s Faulkner Hospital (BWFH) to an audience of more than 1000 fertility surgeons attending the 68th Annual Meeting of the American Society for Reproductive Medicine (ASRM) meeting in San Diego, California. Over the course of two hours, Dr. Gargiulo narrated the ongoing surgery while answering a steady stream of questions from the audience via three moderators.

Dr. Gargiulo and members of the robotic team at the Center for Infertility and Reproductive Surgery (CIRS)  were chosen by ASRM to broadcast the procedure based on their innovative work in robotic reproductive surgery, such as performing the first single incision robotic myomectomy in 2012.

Two innovations pioneered by CIRS physicians at BWH were demonstrated during the live surgery.  The first was the use of a flexible carbon dioxide laser to remove the patient’s fibroid tumor. This new type of laser, developed at the Massachusetts Institute of Technology, has been successfully used in neurosurgery and otolaryngology (ear, nose and throat) surgeries. Carbon dioxide lasers can be aimed precisely and their energy is very focused. Such focus and precision, Dr. Gargiulo notes, means there is little impact on surrounding tissues, which is very important in delicate reproductive surgeries.

Dr. Gargiulo’s live robotic myomectomy also demonstrated the use of a new technique that positions the robotic arms so that there are no visible scars above bikini line, addressing the cosmetic concerns of many patients.

The October 2012 ASRM live broadcast marked another milestone for the BWH Center for Robotic Surgery, which has become the largest multi-specialty robotic surgery program in the Boston area, offering a variety of urologic, gynecologic, otolaryngologic, thoracic, and general surgery robotic procedures. Since the Center for Robotic Surgery was established twelve years ago, BWH surgeons have performed more than 2,000 robotic surgeries, more than any other institution in the Boston area.

As Director of Robotic Surgery, Dr. Gargiulo predicts that the number and indications of robotic procedures offered at BWH will continue to grow due to the desire of patients to avoid open surgeries and recognition about the benefits of minimally invasive surgery (decreased blood loss, post-surgical pain and need for postoperative pain medication, as well as faster recovery and return to normal activities and decreased scarring).

Dr. Gargiulo emphasizes that physician skill and experience are essential for patient safety, but other factors also come into play. He notes that BWH was the first in the region to create a detailed process to qualify its surgeons to perform robotic surgery. It also has developed an extensive training program for resident physicians and clinical fellows. Finally, investments in state-of-the-art digital simulators at both campuses (BWH and BWFH) provide physicians with the opportunity to continually refine their surgical techniques. Dr. Gargiulo points to the safety benefits resulting from digital simulation for airline pilots as an example of how digital simulation can ensure the highest safety levels for patients undergoing robotic surgery.

Despite the emphasis on technology, surgeons like Dr. Gargiulo never lose sight of the focus on patients. He reports that his star patient, whose surgery was broadcast live to the other side of the country, left BWFH four hours after waking up from her anesthesia and has made a full recovery. The patient, a delightful 29-year-old newlywed who was suffering from dangerous levels of anemia due her fibroid tumor, resumed normal activities within two weeks of her surgery.  She is looking forward to her future and becoming a parent one day.

Visit the BWH Center for Robotic Surgery to view videos that give an inside look of what happens during robotic surgery, hear testimonials from BWH patients who have benefited from robotic surgery, and learn about the surgeons who perform robotic procedures.

– Jamie R

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