Robotic Assisted Hysterectomy
What is robotic assisted hysterectomy?
Robotic assisted hysterectomy is a type of surgery that uses surgeon-controlled robotic equipment to remove your uterus.
Hysterectomy is the surgical removal of the uterus. The uterus is a hollow, muscular organ located in a woman’s pelvis. Having a hysterectomy ends menstruation and the ability to become pregnant. Depending on the reason for the surgery, a hysterectomy may also involve the removal of other organs and tissues, such as the ovaries and/or fallopian tubes.
A robotic assisted surgery system consists of two separate pieces of equipment. One robotic piece of equipment is located next to the patient in the operating room. This robotic piece has four arms, which are long thin tubes that are attached to either a thin surgical instrument or a tiny camera. The surgical instruments and camera enter the patient’s body through small ½ inch cuts (incisions) in the abdomen.
A short distance away from the operating table, the surgeon is seated in front of a separate computerized piece of equipment that looks like a video game. The surgeon controls the movements of the robotic arms and instruments with hand-held controls. The surgeon looks through binocular-like lenses on the equipment and a computer generates a three-dimensional view of the operating area. Foot pedals control the camera and allow the surgeon to zoom in or out to change the surgical view.
In what ways does robotic assisted surgery help the surgeon?
The robotic assisted surgery is a computer-enhanced surgical system that gives surgeons the advantages of:
- A 3-D view of the surgical field, including depth, up to 15 times the magnification and high resolution
- Instruments that mimic the movement of the human hands, wrists and fingers, allowing an extensive range of motion that is more precise than the surgeon’s natural hand and wrist movements
- A constant steadiness of the robot arms and instruments and robot wrists that make it easier for surgeons to operate on organs and tissues for long periods of time and from angles and positions they would have difficulty reaching with human hands and fingers
The surgeon controls every precise movement of the robotic arms and instruments. The robotic arms cannot move on their own.
Who may benefit from robotic-assisted hysterectomy?
Robotic assisted hysterectomy may be especially helpful in:
- Patients who are obese
- Patients who have endometrial cancer
- Patients who have complex surgical cases, such as advanced stage endometriosis or pelvic adhesive disease (scar tissue that binds nearby organs together)
You and your surgeon will discuss if robotic assisted surgery is possible and appropriate for your specific condition.
What happens before and during robotic assisted hysterectomy?
Before the procedure
Before your surgery, your doctor will perform a physical exam, order blood and urine tests and may order other tests to check your general health. Your doctor will tell you which of your current medications can continue to be taken and which will need to be temporarily stopped before surgery. You will be given instructions on when to stop eating and drinking the evening before and morning of your surgery. Your surgeon will explain the procedure in detail, including possible complications and side effects. He or she will also answer your questions.
On the day of surgery:
- A urinary catheter may be inserted to empty your bladder
- Your abdominal area will be cleaned with a sterile solution
- An intravenous (IV) line will be placed in a vein in your arm to deliver medications and fluids
During the procedure
After receiving anesthesia, your surgeon will make four or five small surgical cuts (incisions) in your abdomen (belly). The thin surgical instruments and tiny lighted camera attached to the arms of the surgical robot are inserted into the abdomen through these incisions.
The surgeon controls the precise movement of the robotic arms, surgical instruments and camera while seated at a computer console. Members of the surgical team stand next to the operating table to change the robotic instruments and provide other assistance to the surgeon as needed.
Your surgeon typically removes the uterus through the vagina, like when delivering a baby. In certain cases, the uterus is removed through the small incisions in your abdomen.
An anesthesiologist monitors your anesthesia and vital signs throughout your operation.
How long does robotic assisted hysterectomy take to complete?
Robotic assisted hysterectomy typically takes between one to four hours to complete, depending upon the surgeon and the complexity of the case.
What’s the typical recovery time with robotic assisted hysterectomy?
Robotic hysterectomy is an outpatient procedure. You may stay in the hospital overnight but some woman can be released the same day of surgery. You will able return to light regular activities the next day (walking, eating, walking up stairs). You can drive in about a week or less at the discretion of your physician and return to exercising in about four to six weeks. Your doctor will review your progress and tell you when you can return to your normal activities.
Risks / Benefits
What are the advantages of robot-assisted surgery for patients compared with traditional open surgery?
Compared with traditional open surgery, the benefits of robotic assisted surgery may include:
- Less blood loss during surgery
- Smaller incisions with less scarring. Surgery is performed through small incisions instead of the large incision of open surgery
- Less post-op pain
- Decreased risk of infection
- Shorter hospital stay
- Shorter recovery time and quicker return to previous activities. You can usually resume normal activities as soon as you feel up to it.
What are the risks of robotic hysterectomy?
Robot-assisted hysterectomy takes more time compared to other hysterectomy methods, such as traditional open hysterectomy performed by a surgeon. Longer surgeries may increase your risk for complications.
Like any surgical procedure, robotic hysterectomy carries risks including:
Recovery and Outlook
What is the prognosis (outlook) for people who have robotic hysterectomy?
Most women recover from robotic hysterectomy in less time and with less pain compared to traditional, open hysterectomies. Because the incisions are small, people can return to their daily activities more quickly. With the exception of hysterectomy for cervical cancer, outcomes with robotic surgery are as good as open surgery with shorter recovery. Robotic surgery is NOT recommended for hysterectomies done for cervical cancer as cancer-related outcomes are significantly worse.
When to Call the Doctor
When should I call my doctor?
If you have robot-assisted hysterectomy and develop any signs of complications, such as increased pain, bleeding, or fever, contact your doctor immediately.
Robotic hysterectomy is not for everyone. Your doctor determines if the procedure is right for you based on your diagnosis and needs and your personal state of health. For example, if you have heart or lung conditions that would prevent total sedation, robotic assisted surgery would not be an option.