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Robotic-Assisted Hysterectomy

Robotic-Assisted Surgery is a newer way to perform a variety of surgeries. In Gynecology, the robot is used to assist with many surgeries that were previously done either by Traditional Laparoscopy (surgery through small incisions in the abdomen) or by making a large incision in the abdomen (Abdominal Hysterectomy). Compared to other surgical approaches, the robotic system allows for better viewing of the body with 3-D vision and for better handling of the patient’s anatomy with less trauma and more flexibility. This method of surgery allows the surgeon to perform more complicated surgeries with more precision and less chance of needing to convert to an open abdominal surgery with a much larger incision.

This translates into:
· less postoperative pain
· much smaller incisions
· less risk of infections
· less blood loss
· shorter hospital stays
· shorter recovery time for the patient

The most common surgery a Gynecologist will perform with the robot to assist is a hysterectomy, although the robot may also be used for several other types of surgery as well.

General Information about Hysterectomy

Hysterectomy means removal of the Uterus. It is a way to treat many types of problems involving the uterus and/or cervix. Hysterectomy often, but not always, cures the condition being treated. Sometimes the cure is only partial. No matter how the Hysterectomy is performed, it is still major surgery and requires sufficient recovery time. Many conditions may respond to other treatments that are less invasive and often just as effective. For those conditions that have not responded to alternative treatments, hysterectomy may be the best choice for treatment.

Reasons for Hysterectomy:
1. Uterine Fibroids
2. Chronic Pelvic Pain, including Endometriosis
3. Uterine Prolapse
4. Abnormal Uterine Bleeding
5. Cancer of the Uterus or Cervix

Types of Hysterectomy:
1. Total Hysterectomy- Removal of Uterus and Cervix only. Ovaries are NOT automatically included.
2. Subtotal (Supracervical) Hysterectomy- Removal of upper Uterus only and leaving the Cervix in place.
3.Radical Hysterectomy- Removal of Uterus, Cervix and Surrounding Tissues. This is usually done for removal of Cancer.

Associated Surgeries:
1. Salpingo-oophorectomy- Removal of both fallopian tubes and ovaries
2. Oophorectomy- Removal of one or both ovaries
3. Salpingectomy- Removal of one or both fallopian tubes

Surgical Approaches to Hysterectomy:

1. Abdominal Hysterectomy – Removal of the Uterus through a “bikini” cut (a horizontal incision just above the pubic bone) or through a midline, vertical incision. These incisions are usually several inches long. They allow excellent access to the pelvic organs and this approach may be needed for more complicated surgeries. There is more postoperative pain, longer hospital stays, more blood loss, higher chance of infection and longer recovery with this approach.

2. Vaginal Hysterectomy – Removal of the Uterus and Cervix through the vagina. There is usually no abdominal incision with this approach. The patient may have less pain and slightly shorter hospital stay and recovery with this type of hysterectomy compared to an abdominal incision. A vaginal hysterectomy is not always possible given the anatomy of the patient if there are lots of scars (adhesions) or a large uterus. Laparoscopy may also be combined with a vaginal hysterectomy in some cases to increase the chances of a successful vaginal hysterectomy.

3. Laparoscopic Hysterectomy – Removal of the Uterus through several small abdominal incisions. These incisions are usually about one quarter to one half inch in length and are less painful than much larger incisions. A camera is used in one of the incisions to view the pelvis and the other incisions are for surgical instruments. There is less bleeding, pain and infection with this surgical approach. Hospital stays and recovery time are also significantly shorter than Abdominal Hysterectomy. There is a slightly higher chance of injury to the urinary tract compared to Vaginal Hysterectomy however Laparoscopy allows the surgeon better visualization and access to the anatomy in the pelvis. Surgical time is generally longer for Laparoscopy than for Vaginal and most Abdominal Hysterectomies.

4. Robotic Assisted Hysterectomy – Takes what is good about Laparoscopic surgery and improves on it dramatically with better visualization than any surgical approach and with greatly improved handling of the anatomy compared to other surgical methods. Recovery times and hospital stays are the shortest with this surgical approach; however time in the operating room is the longest due to the more technical nature of this surgery. Robotic-Assisted Hysterectomy also allows the surgeon to deal with more complicated problems and anatomy that, in the past, would have made Abdominal Hysterectomy a necessity.

The need for Hysterectomy, type of Hysterectomy and surgical approach is something that you should discuss with your Gynecologist. If you are considering the need for Hysterectomy for your Gynecological problem, please call our office to make an appointment.

For more information about Robotic-Assisted Hysterectomy, please visit www.daVinciHysterectomy.com.