Physicians perform hysterectomy – the surgical removal of the uterus – to treat a wide variety of uterine conditions. Each year in the U.S. alone, doctors perform approximately 600,000 hysterectomies, making it the second most common surgical procedure.
Types of Hysterectomy
There are various types of hysterectomy that are performed depending on the patient's diagnosis:
- Supracervical hysterectomy - removes the uterus, leaves cervix intact; This type of surgery is not recommended for women with a history of an abnormal Pap smear or certain types of pelvic pain.
- Total hysterectomy - removes the uterus and cervix
- Radical hysterectomy or modified radical hysterectomy - a more extensive surgery for gynecologic cancer that includes removing the uterus and cervix and may also remove part of the vagina, fallopian tubes, ovaries and lymph nodes in order to stage the cancer (determine how far it has spread).
Approaches to Hysterectomy
Surgeons perform the majority of hysterectomies using an "open" approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6-12 inch incision. When cancer is involved, the conventional treatment has always been open surgery using a large abdominal incision, in order to see and, if necessary, remove related structures like the cervix or the ovaries.
A second approach to hysterectomy, vaginal hysterectomy, involves removal of the uterus through the vagina, without any external incision or subsequent scarring. Surgeons most often use this minimally invasive approach if the patient's condition is benign (non-cancerous), when the uterus is normal size and the condition is limited to the uterus.
In laparoscopic hysterectomy, the uterus is removed either vaginally or through small incisions made in the abdomen. The surgeon can see the target anatomy on a standard 2D video monitor thanks to a miniaturized camera, inserted into the abdomen through the small incisions. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy alone.
While minimally invasive vaginal and laparoscopic hysterectomies offer obvious potential advantages to patients over open abdominal hysterectomy – including reduced risk for complications, a shorter hospitalization and faster recovery – there are inherent drawbacks. With vaginal hysterectomy, surgeons are challenged by a small working space and lack of view to the pelvic organs. Additional conditions can make the vaginal approach difficult, including when the patient has:
- A narrow pubic arch (an area between the hip bones where they come together)
- Thick adhesions due to prior pelvic surgery, such as C-section
- Severe endometriosis
- Non-localized cancer (cancer outside the uterus) requiring more extensive tissue removal, including lymph nodes
- With laparoscopic hysterectomy, surgeons may be limited in their dexterity and by 2D visualization, potentially reducing the surgeon's precision and control when compared with traditional abdominal surgery.
Benefits of da Vinci Robot-Assisted Gynecologic Surgery
Traditional open gynecologic surgery, using a large incision for access to the uterus and surrounding anatomy, has for many years been the standard approach to many gynecologic procedures. Yet, open surgery can cause significant pain, physical trauma and a long recovery process. For women facing gynecologic surgery, the period of pain, discomfort and extended time away from normal daily activities that usually follows traditional surgery can also cause significant anxiety.
da Vinci enables GYN surgeons to perform more complex operations through just a few tiny incisions, thereby minimizing the need to perform traditional abdominal (open) surgery. As a result, da Vinci GYN surgeons can offer the benefits of minimally invasive surgery to a broader range of patients. Potential patient benefits include:
- Shorter hospital stay (one day in most cases versus 3-5)
- Significantly less pain post-operatively (often only over-the-counter pain meds required)
- Quicker recovery and return to normal activities (1-2 weeks versus 6-8 weeks)
- Fewer complications and less risk of infection
- Less scarring: small, dime-sized incisions versus 6-8 inch scar
As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient and procedure.
If you would like to explore whether you are a candidate for robot-assisted hysterectomy, ask your doctor. For a referral to a Chilton physician, visit our online physician directory or call 1-888-CHILTON.
Surgeons who Perform Robot-Assisted
Gynecological Surgery at Chilton:
Khashayar Shakiba, MD
Robot-assisted hysterectomy, pelvic reconstructive surgery, uterine and vaginal vault prolapse, urinary incontinence, myomectomy, tubal reanastomosis
Steven Domnitz, MD
Robot-assisted hysterectomy, myomectomy, tubal reanastomosis
Shaghayegh DeNoble, MD
Robot-assisted hysterectomy, urinary incontinence, myomectomy
While clinical studies support the effectiveness of the da Vinci System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.
For additional information on minimally invasive surgery with the da Vinci Surgical System visit www.davincisurgery.com.