Ovarian cysts in women in their childbearing years are common and often not a cause for concern. However, when cysts occur during pregnancy, they can present some special issues and in some cases threaten the health of the mother and baby. Recently, an Albany Med surgeon removed an ovarian cyst with the help of a robot.
Jessica Drake with Drs. David Kimble
It was only after she moved back home to Hudson Falls, NY, with her 8-year-old son that Jessica became really alarmed. Still in pain, she began to notice that though she was only a few months pregnant, her belly looked as though she was much further along.
Physicians in Glens Falls detected a cyst the size of a grapefruit on Jessica’s ovary and referred her to Dr. Scott Dexter of Albany Med’s Maternal Fetal Medicine Group. Dr. Dexter determined that though the cyst appeared to be benign, it had to be removed due to its size and the pain it was causing. If the ovary “twisted,” emergency surgery would be dangerous to the fetus.
“That was scary. I had to do something,” says Jessica.
In some cases, removal of a cyst during pregnancy can be done laparascopically (minimally invasively) using much less anesthesia than in traditional surgery. Unfortunately, in Jessica’s case, Dr. Dexter knew this was not possible. Because of its size and location, removing this cyst laparoscopically would have been dangerous.
“The instrumentation is very limited in its dexterity and we would have had to physically displace the uterus in order to detach the blood supply. This would have placed obvious risk on the fetus,” he said.
The likely course of action for Jessica was to undergo “open” surgery, a several-hour surgery performed under general anesthesia. However, Dr. Dexter wondered if there was a third option. He approached his colleague, Dr. David Kimble, a urogynecologist who had recently joined the practice. He knew Dr. Kimble was skilled in the use of the da Vinci robot in complex gynecological surgeries and wondered if he could remove Jessica’s cyst with the robot, a tool that gives surgeons much more precision and dexterity.
The answer was “Yes.” According to Dr. Kimble, robotic surgery presented the safest and best option for Jessica. “Aside from the obvious benefits of decreased pain and recovery time, performing this procedure robotically would result in less manipulation and tissue damage on the uterus, and decreased risk to the fetus by not opening the womb, and also not exposing it to large amounts of anesthesia.”
While to his knowledge, this had never been done before, he was confident it would work. “We thought, we’ve got the team, the skills and the technology, why not use those to our advantage for the benefit of this patient?” said Dr. Kimble.
Jessica agreed and the landmark surgery was scheduled for when she reached 17 weeks in her pregnancy.
During the hour-long procedure, Dr. Kimble manipulated the surgical arms of the robot with the same precision as the human wrist to “disconnect” Jessica’s ovary and fallopian tube from her uterus and remove those, as well the cyst (a dermoid cyst), section by section. The surgery required just five very small incisions and both Jessica and her unborn child did well.
The next day, Jessica went home and felt her fetus moving for the first time in her pregnancy. And, soon her pain disappeared.
“Having undergone a previous C-section, I know how difficult recovery from a large incision can be,” says Jessica. “I was up and moving that same night of my surgery. It was pretty amazing. It’s important that other patients in similar situations know that this is possible.”