Adhesions are fibrous bands that form between tissues and organs in the abdominal or pelvic cavity, often as a result of previous surgery, infection, or inflammation. They can cause chronic pelvic pain, infertility, bowel obstruction, or complicate future surgical procedures. Adhesiolysis, the surgical removal or separation of these adhesions, has traditionally been performed via open or laparoscopic surgery. However, advances in robotic-assisted surgery, particularly with the Da Vinci Surgical System, have transformed adhesiolysis, allowing for precise dissection, minimal tissue trauma, and improved patient outcomes.

The use of barrier agents such as Interceed—an absorbable adhesion barrier—further enhances surgical outcomes by reducing the risk of adhesion reformation.

Indications for Robotic Adhesiolysis

Robotic adhesiolysis is indicated in patients with:

Chronic pelvic or abdominal pain due to adhesions

Infertility where adhesions interfere with fallopian tube function

Bowel obstruction secondary to intra-abdominal adhesions

Complicated pelvic surgeries where prior adhesions increase surgical risk

Dr. R. K. Mishra and other pioneers in minimally invasive surgery emphasize the importance of accurate preoperative assessment to plan robotic adhesiolysis effectively.

Advantages of Robotic Adhesiolysis

The Da Vinci robotic system provides several advantages over conventional laparoscopy and open surgery:

Enhanced 3D Visualization – High-definition, magnified views of the operative field allow precise identification of adhesions.

Improved Dexterity – Robotic instruments with wrist-like articulation enable meticulous dissection in confined spaces.

Stable Platform – Reduces tremor and facilitates delicate tissue manipulation.

Minimized Tissue Trauma – Precise dissection decreases the risk of injury to organs such as bowel, bladder, ureters, or fallopian tubes.

Shorter Recovery – Patients experience less postoperative pain, reduced hospital stay, and faster return to normal activities.

Preoperative Preparation

Successful robotic adhesiolysis requires thorough preparation:

Patient Evaluation: Complete medical history, prior surgical history, imaging studies (ultrasound, CT, or MRI) to locate adhesions.

Anesthesia Assessment: General anesthesia is required.

Informed Consent: Discuss procedure, risks, benefits, and potential need for conversion to open surgery in cases of dense adhesions.

Bowel Preparation: May be recommended if adhesions involve the intestines.

Surgical Technique
Port Placement and Docking

The patient is positioned supine or lithotomy depending on adhesions and targeted structures.

Typically, three to four robotic ports are inserted along with assistant ports for suction and retraction.

The Da Vinci robot is docked, providing the surgeon with a 3D console view of the surgical field.

Adhesiolysis

Adhesions are carefully identified, often using blunt and sharp dissection techniques.

Robotic instruments allow for precise separation of adhesions without damaging underlying structures.

Hemostasis is achieved using energy devices with minimal thermal spread.

Application of Interceed

After adhesiolysis, Interceed—an oxidized regenerated cellulose adhesion barrier—is applied to raw or traumatized surfaces.

Interceed acts as a physical barrier, preventing adjacent tissues from adhering during the healing process.

Proper placement is critical; the barrier must fully cover the dissected area without gaps.

Inspection and Completion

The operative field is inspected for bleeding, tissue integrity, and adequate placement of Interceed.

Instruments are withdrawn, and ports are closed.

Postoperative Care

Pain Management: Typically mild to moderate, managed with analgesics.

Early Ambulation: Encouraged to reduce the risk of venous thromboembolism and promote bowel function.

Diet: Gradual resumption as tolerated.

Follow-Up: Assessment of pain relief, recovery, and reproductive outcomes if applicable.

Outcomes

Robotic adhesiolysis with Interceed application has shown:

Effective adhesion removal with minimal complications

Reduced recurrence of adhesions due to the barrier effect

Improved fertility outcomes in patients with tubal adhesions

Faster recovery and high patient satisfaction compared to open adhesiolysis

Clinical studies and surgical experience indicate that robotic precision, combined with anti-adhesion barriers, represents a significant advancement in minimally invasive surgery.

Risks and Complications

Although generally safe, potential risks include:

Injury to bowel, bladder, or ureters

Bleeding or hematoma formation

Infection at port sites or intra-abdominally

Rare systemic reactions to Interceed

Possibility of adhesion recurrence if barriers are improperly applied

Dr. R. K. Mishra emphasizes that meticulous surgical technique, careful patient selection, and proper barrier application are essential to minimize risks and optimize outcomes.

Conclusion

Da Vinci robotic adhesiolysis with Interceed application represents a cutting-edge approach for managing intra-abdominal and pelvic adhesions. By combining enhanced visualization, precision instrument control, and adhesion prevention strategies, this technique improves safety, reduces postoperative complications, and enhances patient recovery. It is particularly beneficial in complex cases involving infertility, chronic pain, or prior surgeries, where conventional methods may fall short.

Robotic adhesiolysis, when performed by skilled surgeons like Dr. R. K. Mishra, sets new standards in minimally invasive surgery, demonstrating the potential of technology to improve patient outcomes and quality of life in challenging surgical scenarios.