Robotic Hysterectomy

What Is A Robotic Hysterectomy?

A hysterectomy is a surgery to remove a woman’s uterus. This surgery is most commonly performed through a long open incision (open hysterectomy) either horizontally like a c-section or if the uterus is enlarged above the belly button vertically from the breastbone to the pubic hairline. However, for smaller fibroid-filled uteruses, hysterectomy can be performed laparoscopically, or occasionally, vaginally.

Laparoscopic hysterectomy can be performed in two general types: traditional or robotic. The approach is the same but the difference is who is holding the instruments that are being used to perform the hysterectomy. If it is the surgeon herself/himself, it is the traditional approach. If it is robotic arms being manipulated by the surgeon, it is robotic. Both are performed using a lighted scope equipped with a camera so-called a laparoscope and are done through very small incisions.

The robotic-assisted laparoscopic hysterectomy utilizes a computer located in the operating room and it gives the surgeon more control and precision over the surgical instruments by allowing access to tiny spaces while providing a high-definition 3D magnified view of the surgical area.

This technology was designed for operating in these tiny, delicate spaces where the highest precision can make a difference in surgical outcomes. Hysterectomy, however, is not a surgical procedure that requires this level of precision. It is essentially an amputation. There are clamps placed on either side of the uterus to control the blood flow to the uterus and then the uterus can be removed surgically. Therefore, the decision to perform a hysterectomy versus other treatment options like Uterine Fibroid Embolization AND the type of hysterectomy needs to be discussed and agreed upon by the physician and the patient.

Robotic hysterectomy is not something that requires the additional precision of a computer-assisted robot and ends up costing the patient several thousand additional dollars with no clear benefit to her.

Why Is A Robotic Hysterectomy Performed?

There are many female health issues that may prompt doctors to recommend a hysterectomy surgery. Robotic hysterectomy surgery may be performed to address:

• Non-cancerous fibroid tumors;
• Tumors caused by cancer;
• Prolapsed uterus – the uterus is migrating down into the vaginal area;
• Endometriosis – pain and bleeding caused by cells originating from the lining of the uterus but growing outside of the uterus;
• Prolonged abnormal uterine bleeding from other causes;
• Pelvic pain that is chronic.

Who Is A Candidate For A Robotic Hysterectomy?

A robotic hysterectomy may be recommended if your doctor believes that you are not a candidate for a vaginal hysterectomy. If you have scarring from previous surgeries or if your uterus is enlarged significantly by fibroids, a vaginal hysterectomy may not be an option, and a robotic hysterectomy may be an option.

What to Expect From Robotic Hysterectomy Surgery?

Robotic hysterectomy surgery is performed under general anesthesia, typically by placing a tube in your airway that will provide oxygen to you while you sleep during the procedure. You will most likely have a catheter placed in your urethra and advanced into your bladder to drain urine and will be given special stockings to wear to prevent blood clots.

Several small incisions will be made around your belly button area and carbon dioxide gas CO2 is pumped into your belly to help the surgeon gain better access to work inside your abdomen. Long metallic tubes (ports) are inserted through the incisions one at a time, and then alighted scope with a camera is inserted into one of the ports, and surgical instruments are advanced into the other ports with the help of the robotic arms. These arms are controlled by the surgeon working with a sophisticated computer to dismantle your uterus (morcellation) and removed it through the instrument ports.

The entire uterus may be removed, or all of the uterus above the cervix (supracervical hysterectomy), or the ovaries, fallopian tubes, and the uterus (total hysterectomy), depending on the reason for the hysterectomy. The incisions are closed with a few stitches when the surgery is completed.

Recovery From Robotic-Assisted Hysterectomy

You will wake up in the recovery room where you will be cared for while you recover from the general anesthesia. Some women feel nauseous after being under general anesthesia but it normally only lasts a few hours. A hospital stay of 1- 2 days is typically required after surgery.

You can expect:

• Some pain after the procedure which will be alleviated by IV pain medication while you are in recovery.
• After you have met a few required milestones in recovery, you will be moved to a hospital room where you will stay at least overnight.
• You will be encouraged to get up and walk to help prevent blood clots from forming and causing complications.
• You will be sent home with a prescription for pain medication, wound care instructions, and aftercare directives from your surgeon.
• You will have light bleeding for several days similar to a light period.
• You will be instructed not to lift anything heavy until you are cleared to do so.
• You will have to refrain from having intercourse for six weeks.

Recovery typically takes three to four weeks for traditional or robotic hysterectomy vs six to eight weeks for the more common open abdominal hysterectomy.

Risks And Side Effects of Hysterectomy:

• Adverse reaction to the anesthesia;
• Infection;
• Bleeding requiring transfusion;
• Damage to bladder or ureter requiring urinary diversion;
• Damage to the bowel requiring abscess drainage and separate surgical repair;
• Blood clots in the legs (deep vein thrombosis) that may travel to the lungs (pulmonary embolus);
• Early menopause (hot flashes, vaginal dryness) that may require hormone therapy;
• Loss of the ability to become pregnant.

Uterine Fibroid Embolization (UFE) Vs. Robotic Hysterectomy

If your doctor recommends a robotic hysterectomy due to benign uterine fibroids, you should consider getting a second opinion from an Interventional Radiologist experienced in Uterine Fibroid Embolization (UFE). UFE is outpatient and completely non-surgical and therefore hysterectomy should be a last resort option for treating uterine fibroids.

Uterine fibroid embolization is 90% effective in getting rid of fibroid symptoms, including heavy bleeding. It shrinks and destroys all the fibroids by blocking the blood supply that is feeding them and helping them grow.

UFE allows a woman to keep her uterus fully functional, without risks and complications from fibroid surgery. UFE has a much shorter recovery time usually 5-7 days, allowing a woman to quickly return to normal life and in almost every case, improve the quality of life significantly due to alleviating the fibroid symptoms.

If you have been diagnosed with uterine fibroids and have been told you need to have a robotic hysterectomy or myomectomy, please seek a second opinion from an experienced Interventional Radiologist specializing in UFE. Contact Atlanta Fibroid Center at (770) 953-2600 or make an appointment online to see if you are a candidate for uterine fibroid embolization.