Doc Talk: Robotic hysterectomy offers advantages for patient, surgeon

One in three women will undergo a hysterectomy, making it one of the most common surgical procedures performed every year.

For decades, the standard procedure was an abdominal hysterectomy that involved a skin incision similar to a C-section and a hospital stay of three to five days, followed by a lengthy six-week recovery period. Then vaginal hysterectomy allowed for shorter hospitalization and recovery but was limited to a select subgroup of women.

The introduction of laparoscopy allowed for the laparoscopic-assisted vaginal hysterectomy, providing options for a larger group of patients along with shorter hospital stays and recovery times. However, the laparoscopic approach had limitations and was often abandoned for the abdominal approach in technically difficult cases.

Enter the robotic hysterectomy, a revolutionary advance in technology that allows surgeons to exceed the capabilities of their own hands and eyes. It also gives women even shorter hospital stays and quicker recovery.

Today, a woman who previously would have been a candidate for abdominal hysterectomy has a procedure that lasts one to two hours. She is able to go home later that day or the following morning, with three to five incisions about the size of a keyhole on her abdomen.

Additional advantages

The robot has other distinct advantages. First, the surgeon is able to manipulate the instruments with 360 degrees of rotation — more than the human wrist is able to do — unlike laparoscopy, which is rigid and limited in mobility.

Secondly, the camera provides a significantly magnified view with true 3D vision. The robot gives surgeons the feeling of standing in the surgical field and the ability to move with unparalleled precision.

Recent studies indicate that patients undergoing robotic hysterectomy can experience less blood loss, fewer surgical complications and less postoperative pain.

The robot offers the surgeon an ergonomic bonus: a great improvement over standing and straining with laparoscopy or trying to focus on a surgical field three feet below your eyes. Instead, the surgeon sits 20 feet away from the patient in a comfortable chair, manipulating the surgical instruments in an unmatched field of view.

How does it work?

From a procedural standpoint, the robotic version is similar to any hysterectomy. The ligaments and blood vessels are taken down in the same manner as the laparoscopic or open approach. Once the uterus and cervix have been dissected completely, they are removed through the vagina, and the surgical opening is then repaired with the robot from above.

If the uterus is significantly enlarged, it can be dissected easily in halves or quarters, allowing for easy delivery through the vagina.

What if I have cancer?

In most cases, ovarian cancer, uterine cancer and cervical cancer require a hysterectomy. As you can imagine, these are not average hysterectomies for abnormal uterine bleeding, but involve extensive tissue dissection and lymph node retrieval.

Five years ago, it was expected that many postoperative patients undergoing gynecologic cancer surgery would have extended hospital stays, often with complications associated with both the cancer and the long recovery. Now many of these patients are home the next day and mobile much sooner, preventing many complications previously encountered.

Fortunately for Wichita, we are blessed with two excellent gynecological oncologists who perform robotic hysterectomies for many cancer patients.

All of this does not mean there is no place for the vaginal, laparoscopic-assisted, total laparoscopic or abdominal hysterectomies. If your doctor recommends any of these, it is for a good reason and they are all still used every day in this country.

Many of you reading this may be a candidate for a hysterectomy someday. If you are concerned because you have had either numerous abdominal surgeries or multiple C-sections, are obese, have fibroids or feel your medical condition will complicate an otherwise routine hysterectomy, rest assured.

There's a robot in your future, and you can plan on going home the next day.

This story was originally published October 4, 2011 at 12:00 AM with the headline "Doc Talk: Robotic hysterectomy offers advantages for patient, surgeon."