Robotic Training Epicenter: Uro-Gynecological Surgery

Continuing its commitment to offer the latest options in minimally invasive and advanced surgical techniques, Sarasota Memorial Hospital and urologic surgeon Robert I. Carey, MD PhD FACS, have been designated as the first and only Robotic Surgery Training Epicenter in Florida focusing on Robotic Complete Female Pelvic Floor Reconstruction for vaginal vault prolapse and urinary incontinence in women.

Dr. Carey and Sarasota Memorial were recognized by Intuitive Surgical as a center of excellence because of its expertise, superior patient outcomes and ability to teach best practices to future robotic surgeons learning how to perform robotic pelvic floor reconstruction (sacralcolpopexy). 

Led by Dr. Carey, the training epicenter at Sarasota Memorial is one of just three programs across the nation to earn the distinction for urogynecological procedures. As an official Epicenter training site, Sarasota Memorial hosts surgeons from across the nation as they study specialized surgical techniques by observing Dr. Carey in the hospital ‘s da Vinci surgical suites.

Dr. Carey has long served as a training site for surgeons who wished to learn how to perform robotic surgery for prostate cancer in men as well as complex robotic surgery for urologic reconstruction. The new designation as a training Epicenter recognizes his vast experience with a diversity of cases. Dr. Carey has performed over 2,000 major urologic and urogynecological procedures since he arrived in Sarasota in 2006, the majority of which have been done robotically. He also has built a strong reputation for repairing the complications of surgery in both men and women, so visitors to the Epicenter are able not only to see how to perform surgery safely, but also to discuss how to manage complications and unusual circumstances or anatomy

Robotic surgery is one of the most important breakthroughs in women’s surgeries in the past decade. More than 130,000 women will undergo surgery for pelvic organ prolapse each year. Historically, many of these women will undergo transvaginal surgeries with a high rate of reoperation (33% or higher). Robotic sacrocolpopexy as performed by Dr. Carey can reduce this reoperation rate and offer women the opportunity to have a comprehensive female pelvic floor reconstruction with just one surgery, rather than a more lengthy sequence of multiple surgeries and hospitalizations.

Risk factors for female pelvic organ prolapse include: childbirth, advancing age, previous surgery such as hysterectomy, and in some cases just the results of lifting or other activity. Symptoms include chronic pain, discomfort, and dysfunction due to the bulge into or through the vagina. Women may also experience urinary incontinence, urgency and frequency of urination, as well as sexual and bowel dysfunction.

Robotic sacrocolpopexy can be performed with uterus preservation.  
When women present with severe pelvic organ prolapse (their uterus, bladder, rectum, and intestines sliding or herniating into the vagina), they often are offered a hysterectomy as part of the repair. Hysterectomy may be appropriate if there is cancer in the uterus of if the woman is having abnormal bleeding.

However, if the uterus is otherwise normal, women may choose a repair option without a hysterectomy. Dr. Carey's robotic techniques allow for complete female pelvic floor reconstruction with uterus preservation (click here for journal article). To be considered a candidate for uterus preservation, women must have normal pap smears and normal pelvic ultrasounds. Dr. Carey recommends that uterus preservation be performed as part of a multidisciplinary evaluation with the patient’s primary gynecologist.

Robotic sacrocolpopexy can be performed in the “salvage” setting, allowing women who have already had failed previous attempts at repair undergo a subsequent repair robotically. This is important as many women historically will fail their first attempt at prolapse repair. Although salvage procedures are more technically demanding, Dr. Carey has demonstrated techniques for removing previously misplaced vaginal mesh while during the same surgery achieving excellent repair of prolapse (click here for journal article).  

About Robert I. Carey, MD PhD FACS
Dr. Robert Carey earned his medical degree from the Medical College of Georgia, as well as a Ph.D in chemistry from the Massachusetts Institute of Technology. His residency training in surgery and urology, and a fellowship in robotic surgery, laparoscopy and endourology, were completed at the University of Miami in 2006. He has been awarded a National Institutes of Health Fellowship in the Department of Chemistry at Harvard University and has served as an assistant professor at the Institute of Organic Chemistry at the University of Lausanne, Switzerland, and University of Georgia. Dr. Carey has performed more than 1,000 robotic surgeries at Sarasota Memorial Hospital. He was an invited lecturer in robotic female pelvic floor reconstruction and robotic surgery for prostate cancer at the Masters in Robotic Surgery Course for the Society of Robotic Surgeons in 2013.  Dr. Carey is currently a clinical associate professor for the Florida State University College of Medicine and serves as a consulting editor for the Journal of Robotic Surgery. He is a member of the American Urological Association Leadership Class of 2014.  Dr. Carey’s office is located adjacent to the Sarasota Memorial Hospital at 1921 Waldemere Street, Suite 310.     

For more information
Sarasota Memorial was the first hospital in the region to pioneer da Vinci robotic surgery when it purchased the latest generation robot in 2006. Today, it is the region’s leading referral center with three robotic surgery suites and nearly two dozen robotic surgeons who have performed more than 2,200 minimally invasive procedures across a broad range specialties – cardiac, thoracic, urologic, colorectal, bariatric, gynecologic and oncologic surgery. Call Sarasota Memorial's HealthLine at (941) 917-7777. 
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