Surgeons are divided on whether the use of robots offers the more than half-million women each year who undergo a hysterectomy any advantages over other techniques that likewise use small incisions and flexible scopes.

Robotics have been used in heart and prostate surgery for several years now, but more recently, the U.S. Food and Drug Administration approved the technique for gynecological procedures as well.

"I think you have to respect the patient and be very careful with any new technology," said Dr. Stephen Young, president of the Society of Gynecologic Surgeons. "Robotic surgery is new and it's sexy, but in my understanding, the increased value of the robot over standard (procedures) has not been shown."

Dr. Paul Magtibay of the Mayo Clinic Hospital in Phoenix, where surgeons have performed nearly 300 hysterectomies with the help of robots in the last two years, disagreed: "I think you'll see it more and more. It's a technology that's here to stay."

Robot-assisted surgery is the latest development in the larger trend toward laparoscopy, where surgeons make small incisions in the abdomen and insert thin flexible tubes, or laparoscopes, that are threaded with tiny cameras and surgical instruments. Traditional hysterectomy requires an abdominal incision of four to five inches.

Smaller incisions mean less pain, scarring and bleeding for the patient, and faster recovery times. But laparoscopic surgery through the abdomen also poses a higher risk of complications for hysterectomy patients. They have a 5 percent chance of severe blood loss following surgery — nearly double the risk of patients undergoing the traditional approach, according to WebMD.com.

With robotic surgical systems, such as the $1.4 million da Vinci robot in use at Miami Valley Hospital and Kettering Medical Center, surgeons don't move the tiny instruments directly with their hands. Instead, they sit at a console several feet away from the operating table and, while watching a magnified 3-D view of the surgical area, use foot and hand controls to manipulate the tiny instruments inside the patient's body.

An obvious advantage is that the robotic system eliminates any hand tremor in the surgeon. But a disadvantage is that surgeons guiding the robotic instruments can't feel the tissues they are probing and cutting.

"Without the feel between me and the patient, I would feel compromised," Young said. "It would be like taking away one of my senses."

But Magtibay said the improved 3-D visualization with robotic surgery and the intuitive movement of its hand controls more than compensate for the loss of feel. "With standard laparoscopy, you get only a two-dimensional view — you lose that depth perception," he said.

But like any machine, robots that assist in surgery are only as good as those trained to use them. Magtibay said surgeons need to do 10 or more robotic hysterectomies in order to feel comfortable with the technique, but that's still far fewer than the 20 or 25 procedures needed to get up to speed with standard laparoscopic surgery, he said.

But Young argues that technology is no substitute for a surgeon's training and skill.

He said the technique with the lowest cost, lowest complication rate and least pain for women also is the most difficult for surgeons to learn — a vaginal hysterectomy. In that procedure, a surgeon removes the uterus and cervix through an incision at the top of the vagina. Often, it can be done as an outpatient under a regional rather than a general anesthetic, and it leaves no visible scar.

Despite advances in laparoscopic and vaginal techniques, the traditional open abdominal hysterectomy still accounts for two-thirds of the 600,000 hysterectomies performed each year in the United States. Open abdominal hysterectomies leave visible scarring and require a longer hospital stay and a longer recovery period, up to six weeks.

Yet it continues to be the mainstay of most gynecologists because the learning curve is steeper for less invasive procedures, Magtibay said.

Magtibay says robotics' real contribution to gynecology may be in reducing the number of open abdominal hysterectomies. "Robotic assistance makes laparoscopy extremely simple," he said.

But, Young asks, does it make things better for the patient? "That's the big question we're trying to answer in gynecological surgery. Is there a benefit to the robot, or is it simply a very expensive gimmick."

Magtibay said the Mayo Clinic Hospital is now studying whether robotic hysterectomies cause less pain to patients than standard laparoscopic procedures because there appears to be less pulling and tugging on internal tissues.

"We really don't know yet," he said.

Contact this reporter at (937) 225-2437 or jdebrosse@DaytonDailyNews.com.