Indian-American urologic surgeon Ashok Hemal and colleagues have performed more robot-assisted laparoscopic surgery to repair abnormal openings between the bladder and vagina known as fistulas than any other team in the world.
So far, Hemal and his team have successfully operated on a total of seven patients - the highest number anywhere in the world to go through the robot assisted procedure.
"There was less blood loss with this procedure than with conventional surgery and there is the potential for a faster recovery," said Hemal, director of the Robotic and Minimally Invasive Urologic Surgery Programme at Wake Forest Baptist Medical Centre.
"The results were outstanding and suggest the robot-assisted surgery is an attractive option for fistulas that would normally require abdominal surgery," he said.
This type of fistula can result in frequent urinary tract infections and the leakage of urine from the vagina and can be mistaken for continence.
All women had previously undergone unsuccessful surgeries to repair the problem. In most cases, the patients in the report would undergo abdominal surgery requiring a large incision.
Instead, centimetre-sized instruments and a small camera were inserted through five small incisions in the abdomen.
Robot-assisted surgery is a popular option for heart and prostate surgery and in recent years physicians have started using it for other procedures.
The da Vinci surgical system has four robotic arms with centimetre-sized instruments attached. The surgeon controls these arms with hand and finger movements while viewing the surgical site on a screen.
The tiny instruments - as well as the ability to see the surgical site at 10-fold magnification - allow for very precise, refined movements.
The type of fistula that the surgeons repaired can occur one to six weeks after gynaecologic or obstetric surgery, such as a hysterectomy.
Fistulas in other areas can often be repaired with a vaginal approach or with laparoscopic surgery, which uses a camera and small incisions - but is not robot-assisted.
"Robot-assisted surgery has promise to bridge the limitations of laparoscopic surgery and allow more women with fistulas, urinary incontinence or prolapsed pelvic organs to benefit from a minimally invasive approach," said Hemal in a forthcoming report.
His co-authors are Surendra Kolla and Penkaj Wadhwa, both from the All India Institute of Medical Sciences, New Delhi.
Their report appears in the online Journal of Urology and will be included in a future print issue.