Robotic Hysterectomy

Introduction

Hysterectomy is a major surgical procedure where the uterus is removed from the pelvis of a women. Hysterectomy is the most common gynecological surgery performed in the United States after caesarean section and D & C. On average 500,000 hysterectomies are performed each year. The most common route by which hysterectomy is performed is call Total Abdominal Hysterectomy where an incision is placed over the lower part of the abdomen either vertically (midline or para midline incision) or horizontally (Pfannensteil incision or “bikini cut”) and the uterus is removed through this incision. This type of hysterectomy is associated with longer recovery time, usually 6 to 8 weeks, more pain requiring more pain medications, slower recovery, increased risk of wound infection, wound breakdown and hernia formation.

Recently in the last 2 decades technology has allowed us to perform simple total hysterectomies using laparoscope introduced through small 5 mm incisions placed at the umbilicus. These new surgical techniques commonly known as “key hole” surgeries have become popular as there is no scar, healing is faster with less pain and less chance of infection and adhesions. Patients usually recover within 2 to 4 weeks and are back to work. The draw back of these “key hole” surgeries is that complex cases could not be done this way. For example when the uterus is enlarged to more than 14 weeks gestation size, multiple fibroids in the uterus, prior multiple surgeries like caesarean sections etc.

New technologies emerged where by these limitations were overcome of robotic surgery is the most promising. Here through the laparoscope two or 3 robotic arms which are almost like the wrist and hands of the surgeon are introduced and the surgery is performed. The robot also give the surgeon 3 dimension view as well as depth perception which is not available in conventional laparoscopy. Using this robotic technology we are doing complex cases which could otherwise be done only by opening the abdomen. The center for Reproductive Medicine and Robotic Surgery has developed expertise in doing complex gynecological cases like hysterectomies where the uterus is enlarged to 20 weeks or more, multiple myomectomies, advanced stage endometriosis, tubal micro surgery etc. Please click the link here to view such complex surgeries done by Dr. Jacob who is a certified robotic surgeon and a national proctor who trains other doctors in these types of complex cases.

Commonly Asked Questions

What are the common causes for hysterectomy?

The most common cause for performing hysterectomy is heavy menstrual blood loss. Other causes include uterine fibroids, pelvic pain, endometriosis, uterine cancer etc.

What is the recovery time? How much is the pain?

The recovery time is more related to the approach for the hysterectomy. For example a traditional abdominal hysterectomy may take up to 6 to 8 weeks to recover while it is significantly lower with laparoscopic hysterectomy usually 2 – 4 weeks and much faster with robotic hysterectomy usually 1 – 2 week. The pain after surgery is much less with robotic and laparoscopic hysterectomy.

My OB/GYN tells me that I need a hysterectomy. How do I decide on the type of surgery I should undergo?

The decision to do hysterectomy is a medical decision that is made in consultation with your doctor. The type of surgery is based on multiple medical factors like prior surgery you had, size of the uterus, associated medical conditions like diabetes etc and personal circumstances like how much time off work you can afford, post op pain that you could tolerate, abdominal skin scar etc. Please feel free to make an appointment to discuss these by clicking here.

Once I have made the decision to undergo hysterectomy what are the steps involved?

The first step is to make a pre-op consultation appointment with Dr. Jacob. You may call 314 473 1285 or Click here and register and make appointment (faster). At your initial visit, we will review all your past history and all the testing done so far. You may need an ultrasound scan to assess the size of the uterus and also to assess the blood flow to the uterus. If you are over the age of 40 years or have a strong family history of uterine cancer you may need endometrial biopsy (usually done at the same time as the ultrasound scan) to rule out cancer of the uterus.

Once the testing is done how soon I can get the hysterectomy surgery done?

The Center follows a strict policy of first come first basis. Usually all surgeries are scheduled within 2 to 4 weeks. Patient wishes, availability of the robot at the hospital and insurance clearance for surgery are the usual factors affecting scheduling of the surgery. Hence we request all patients to provide us with the correct and up to date insurance information at your initial appointment.

Once the surgery is scheduled what should I do?

You will be asked to do pre – op testing usually one week prior to the surgery. This is usually done at the pre-op testing center at the hospital where you would have the surgery. You should stop all anticoagulation medications at least 1 week prior to the surgery and should not take pain ills like motrin, brufen, aspirn, etc. You can take Tylenol. You should report to the hospital 2 hours prior to the surgery.