Robotic-Assisted Hysterectomy

What is robotic-assisted hysterectomy?

A robotic-assisted hysterectomy is a type of hysterectomy your surgeon performs with the help of a robotic machine. Hysterectomy is a surgical procedure to remove your uterus. Your uterus is a hollow, muscular organ in your pelvis. It’s where a fetus grows during pregnancy.

In this type of hysterectomy, your surgeon makes small incisions (cuts) in your abdomen and uses robotic arms to separate your uterus from its surroundings. A robotic hysterectomy is different from a traditional hysterectomy because a surgeon controls the robotic arms with a controller while looking at a screen instead of being over top of your body. The surgeon has complete control over the robotic arms at all times.

There are several methods your surgeon may use to perform a hysterectomy. A robotic hysterectomy is just one of a few methods they may suggest based on your health history and diagnosis. It’s a type of minimally invasive surgery, which means surgery through small incisions.

People who have robotic-assisted hysterectomy often experience less pain, less blood loss and faster recoveries when compared to an open abdominal hysterectomy. Surgeons perform robotic hysterectomy using a da Vinci surgical system. This tool helps surgeons perform a variety of other minimally invasive surgeries.

Why do surgeons use robotic-assisted hysterectomy?

Some of the benefits a robotic-assisted surgery gives your surgeon are:

• A 3D, high-definition view of the surgical field with up to 15 times the magnification.
• Instruments that mimic the movement of human hands, wrists and fingers, allowing an extensive range of motion that’s more precise than natural hand and wrist movements.
• A constant steadiness of the robot arms, fingers and wrists make it easier to operate on organs and tissues for long periods of time and from angles and positions that are typically hard to reach.

Why would someone need a robotic hysterectomy?

Robotic hysterectomy is not for everyone. You and your surgeon will discuss if robotic-assisted surgery is possible and appropriate for you. This type of hysterectomy may be especially helpful if you have obesity or a complex surgical case, such as pelvic adhesive disease (scar tissue that binds nearby organs together).

A hysterectomy treats several conditions. Your healthcare provider may recommend it if you have conditions like:

• Abnormal or heavy vaginal bleeding.
• Severe and chronic pelvic pain.
• Uterine fibroids.
• Uterine cancer.
• Uterine prolapse.
• Advanced stage endometriosis.

What happens in robotic-assisted hysterectomy?

Robotic-assisted hysterectomy is a type of laparoscopic surgery. Laparoscopic surgery is less invasive than traditional surgery. Your surgeon makes several small cuts (less than or equal to 1 centimeter long) on your abdomen, then inserts a laparoscope and other surgical instruments through the incisions. A laparoscope is a thin tube with a light and video camera at the end.

The laparoscope projects the scene of the surgery onto a high-definition video screen. Your surgeon watches the screen to perform the surgery. Robotic-assisted surgery means they control the surgical instruments using robotic arms, while sitting at a computer console a few feet away.

Before the procedure

Before your surgery, your healthcare provider will perform a physical exam. They may order blood, urine and other tests to check your general health. Your surgeon will explain the procedure in detail, including possible complications and side effects. They’ll also answer your questions about your recovery and what you can expect immediately after surgery.

They’ll give you instructions on when to stop eating and drinking the evening before and the morning of your surgery. They’ll also tell you which of your current medications you can continue taking and which you may need to stop temporarily before the surgery.

On the day of surgery

You’ll arrive at the hospital or surgical center several hours before surgery. In the pre-operative area, a healthcare provider will place an intravenous line (IV) in a vein in your arm to deliver medications and fluid during surgery.

In the operating room after you’re asleep, your healthcare team will:

• Insert a urinary catheter to empty your bladder.
• Clean your abdominal area with a sterile solution.
• Put your arms and legs in the appropriate position for surgery.

Steps of a robotic-assisted hysterectomy

After you receive anesthesia and are asleep, your surgeon will make four or five small incisions in your abdomen. Your surgeon inserts the laparoscope and several small surgical instruments through these incisions. These instruments have robotic arms attached to them.

A short distance away from the operating table, your surgeon sits in front of a piece of equipment that looks like a video game console. Your surgeon controls the movements of the robotic arms with a controller. Your surgeon looks through binocular-like lenses on the equipment and a computer generates a three-dimensional view of the operating area. Foot pedals allow the surgeon to zoom in or out to change their view.

Your surgeon controls every movement of the robotic arms, surgical instruments and camera while seated at the computer console.

Members of the surgical team stand next to the operating table to change the robotic instruments and provide other assistance to your surgeon as needed. There’s always a member of the surgical team at the bedside next to you.

After surgery, your surgeon closes your incisions with stitches and covers them with a bandage.

Robotic hysterectomy is usually an outpatient procedure, which means you go home several hours after surgery. However, there are some people that stay in the hospital overnight.

How do they remove your uterus with robotic hysterectomy?

Your surgeon typically removes your uterus through your vagina, like when delivering a baby. In certain cases, they remove your uterus through the small incisions in your abdomen.

What position are you in during robotic hysterectomy?

You’ll be lying in a slightly reclined position similar to how you lie down during a Pap test or pelvic exam.

Unlike a traditional surgery where your surgeon places their hands in your body, your surgeon will be further away from you during a robotic hysterectomy. They will be in the operating room, but they’ll position themselves at the control center, which may be several feet away from you.

Is a robotic hysterectomy painful?

No, a robotic hysterectomy isn’t painful because you’re asleep for the procedure. However, you may experience pain after surgery. Most people experience slightly less pain recovering from robotic procedures as compared to traditional, open surgery.

How long does a robotic-assisted hysterectomy take to complete?

Robotic-assisted hysterectomy typically takes between two to four hours to complete, depending upon the surgeon and the complexity of the case.

What can I expect after a robotic-assisted hysterectomy?

While less invasive than a traditional open abdominal surgery, robotic hysterectomy is still a major procedure. You’ll need help at home during your recovery, especially for the first few days.

It’s normal to have some vaginal bleeding after surgery and to feel some discomfort. Your surgeon will prescribe medication to help with your pain or recommend over-the-counter (OTC) pain relievers.

Follow your surgeon’s post-operative instructions, which will include things to avoid and when you can return to your normal activities.

What are the risks of robotic-assisted hysterectomy?

Like any surgical procedure, robotic hysterectomy carries risks, including:

• Bleeding.
• Damage to your bladder and other nearby organs.
• Infection.
• Reaction to anesthesia.
• Blood clots that form in the legs and can travel to your lungs.

Overall, these risks are significantly lessened when compared to hysterectomy through a larger incision. Robotic-assisted hysterectomy takes more time to complete than other hysterectomy methods, such as traditional open hysterectomy.

What are the advantages of robotic-assisted surgery compared to traditional open surgery?

Compared to traditional open surgery, the benefits of robotic-assisted surgery include:

• Less blood loss during surgery.
• Smaller incisions with less scarring. Surgery is performed through small incisions instead of a large incision.
• Less pain after surgery.
• Decreased risk of infection.
• Shorter hospital stay.
• Shorter recovery time and quicker return to previous activities.

What is the recovery time for a robotic total hysterectomy?

The average time for a full recovery after robotic hysterectomy is about four to six weeks. You’ll be able to return to light regular activities within 24 to 28 hours after surgery. It’s helpful to have someone assisting you at home during this time, as your activities may be limited and you may be sore and tired. You can usually drive within 72 hours, but this depends on what pain medication you’re taking. Most people can return to work after about two weeks, but this varies depending on what type of job you have.

When will I feel better after a robotic-assisted hysterectomy?

Most people will recover from robotic hysterectomy in less time and with less pain compared to traditional, open hysterectomies.

Depending on why you had a hysterectomy, you may feel relief of uncomfortable symptoms like irregular bleeding or pain. Conversely, some people develop mild symptoms of menopause after a hysterectomy.

It’s normal to have a mix of emotions about the procedure. Some people feel a sense of loss or sadness after a hysterectomy because they’re no longer able to get pregnant and lose their menstrual period.

What can you not do after a robotic hysterectomy?

Your surgeon will provide you with a list of activities to avoid after your robotic hysterectomy. Some examples include:

• Don’t lift anything heavy (more than about 15 pounds) for at least four weeks.
• Avoid sexual intercourse or placing anything in your vagina for at least six weeks.
• Use pads for vaginal bleeding, not tampons. You can expect to have light bleeding for several weeks.
• Keep your incisions clean and dry. Your surgeon may provide specific instructions on how to care for your incisions.
• No bathing or swimming for up to two weeks. You may shower 24 to 48 hours after surgery.
• Try to walk a little each day, gradually increasing the amount of time you walk.
• No strenuous or difficult exercise for at least four to six weeks.

When should I see my healthcare provider?

Contact your surgeon if you’ve had a robot-assisted hysterectomy and develop any signs of complications. Things to watch out for include:

• Redness, swelling, drainage or tenderness at the incision site. These are signs of infection.
• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
• Excessive bleeding.
• Trouble breathing.
• Chest pain.
• Pain that isn’t controlled with medication.

A note from Cleveland Clinic

A robotic hysterectomy is a surgical procedure that uses robotic technology to perform a hysterectomy, the removal of your uterus. Using a robot gives the surgeon a 3D, high-definition view of your pelvis and allows them to make more precise movements. In certain circumstances, your surgeon may suggest using a robot for your hysterectomy as opposed to using a more traditional approach. Don’t be afraid to ask questions so you understand what will happen and how you can best recover from the surgery.