Robotic Hysterectomy

GYN LA is a medical practice that offers comprehensive, compassionate, and quality gynecological care. We provide services in the greater Los Angeles area to women of all ages. We specialize in robotic hysterectomies, a gynecological procedure via robotic surgery that allows us to provide relief and treatment through minimally-invasive means. Robotic hysterectomies are cutting-edge techniques performed with highly sophisticated technology with extensively certified and trained surgeons. They allow GYN LA to provide our patients with the highest standard in care and treatment.

What is a robotic hysterectomy?

A hysterectomy is the surgical removal of a woman’s uterus, also commonly referred to as the womb in everyday English. Conditions that lead to hysterectomy include fibroid uterus, adenomyosis, heavy vaginal bleeding, and cancer. The uterus is a major component of the reproductive system in women and is where fetuses gestate when a woman becomes pregnant. It is composed of various structures, all of which play a major role in reproduction, menstruation, and fetus development. It is attached on its upper end to the fallopian tubes and its lower end to the cervix. The cervix then connects downward in to the vaginal canal. Depending on the underlying medical condition, a surgeon may remove all or only part of the uterus as well as the various anatomical structures connected to it.

A robotic hysterectomy is a surgical procedure that uses a robotic system to perform a partial or complete hysterectomy. It uses the proprietary da Vinci Surgical System, in conjunction with laparoscopic imaging, and is a further improvement over the more traditional vaginal and abdominal hysterectomies. It is a highly innovative, minimally-invasive operation that can only be performed at clinics like GYN LA that specialize in the procedure. The da Vinci Surgical System has become an indispensable tool in robotic hysterectomies and is fairly common: it has been used to operate on approximately two million patients to date. GYN LA doctors have the largest experience with this procedure west of the Mississippi

Benefits of The da Vinci Surgical System

There are numerous benefits of a robotic hysterectomy using the da Vinci Surgical System versus the open surgery of more traditional hysterectomies. These include:

• Shorter recovery time and therefore a shorter hospital stay.
• Less blood loss and fewer post-operative complications.
• Less pain and therefore less need for narcotic analgesics.
• Minimal scarring at the incision site or sites.
• Lower chance of secondary infection following the operation.

One of the primary tools in a robotic hysterectomy is an instrument called a laparoscope. In order for the surgeon to successfully maneuver the surgical tools inside the abdomen, an accurate and highly detailed picture of the internal organs has to be conveyed to the surgeon and their team. A laparoscope is used for this process of imaging. It is essentially a slender fiber optic cable with a tiny camera and light at one end that is inserted in to the patient via a small incision. It then extends out from the incision site and in to the da Vinci Surgical System console. The laparoscope allows the surgeon to obtain images of the surgical site without having to cut a large incision and perform an open surgery, ensuring that the robotic hysterectomy remains minimally-invasive.

The images that the laparoscope records at the surgical site are then magnified and rendered in three dimensions (3D) and high definition (HD). These images are then projected on to stereoptic monitors, meaning that the images on the monitors give the primary surgeon depth perception. This allows the surgical site to be exhaustively mapped out with an incredibly high level of detail. This also results in a level of precision and finesse that translates in to a more successful surgery with less tissue damage or trauma than any other procedure.

The da Vinci Surgical System is housed in the same operating room as the patient. In addition to the primary surgeon, an anesthesiologist, surgical assistant, and occasional secondary surgeon are all present during the procedure. It is composed of two primary sections:

The tower, which is positioned directly over the patient while they are under general anesthesia. It has three arms which hold all the surgical tools necessary for performing the hysterectomy and a fourth that houses the da Vinci system’s 3D/HD cameras. The surgeon who is directly performing the hysterectomy controls the arms via controls contained in the console of the system. The anesthesiologist stays with the patient and the surgical assistant and possible secondary surgeon are usually stationed by the tower.

The console, where the primary surgeon sits and controls the arms in the tower. This is also where the laparoscope connects to the stereoptic monitors that display magnified images of the surgical site in 3D and HD. There are two highly sophisticated and ergonomic master controls which the primary surgeon uses to maneuver the arms and their patented EndoWrist technology.

The EndoWrist instruments are highly innovative pieces of surgical technology that are specifically designed to give surgeons a high level of dexterity while performing the procedure through a tiny incision or incisions. Their design is based on the human wrist and they directly mimic the fine movements of the primary surgeon’s hands and wrists. They are painstakingly calibrated and have far greater mobility and range of motion than traditional surgical tools. For example, the human wrist has 4 degrees of freedom, where “degrees of freedom” is a standard measure of dexterity and movement, while EndoWrist tools have 7 degrees of freedom. They also have 90 degrees of articulation, where “degrees of articulation” is another measure of dexterity and movement, whereas the average human wrist has only 45 degrees. In other words, the EndoWrist instruments are approximately twice as dexterous as the average human hand.

The EndoWrist instruments are entirely integrated in to the larger da Vinci Medical System. They work together seamlessly, with the primary surgeon controlling the entire system. The system could be considered an extension of the surgeon’s expertise and training while providing various additions to the surgeon’s abilities. These include:

Motion scaling, which is the process that converts the larger and wider hand movements of the surgeon in to finer and smaller movements of the surgical instruments at the surgical site.

Tremor reduction, which is the process by which the da Vinci Medical System uses the EndoWrist instruments to reduce the natural tremors in a surgeon’s hands. This is accomplished by having the robot actually execute the movements that are commanded by the primary surgeon at the control console. This further adds to the precision of the surgery and decreases the tissue damage and trauma that are the natural byproducts of any surgical procedure.

Easy access to surgical sites with poor anatomic accessibility. Because the hysterectomy may call for dissection and removal of tissue that is difficult to access due to the patient’s anatomy, the robotic surgical instruments can easily access these areas with an even greater dexterity than the surgeon’s natural hand and wrist movements.

Finer suturing and smaller incisions. A measure of success in a robotic hysterectomy is not only the excision of the diseased tissue or organs, but also the process of suturing up the incision. Because the surgical instruments have so many degrees of freedom and articulation, the sutures and stitches that are sewn in to the patient are finer and result in less scarring and fewer post-operative complications. This, in turn, results in a shorter recovery time and the patient returning sooner to a normal lifestyle. 

The incisions made during a robotic hysterectomy are only 8 millimeters long. 90% of the time the hysterectomy can be completed successfully via a single incision on the inside rim of the belly button. If more incisions are necessary, no more than 3-4 are usually required. Compare this to a more traditional abdominal hysterectomy, which is an open surgery via the abdomen, where the surgeon makes an incision that is approximately 7-10 centimeters long. This is roughly ten times longer than an incision in a robotic hysterectomy.

What is the recovery time for a robotic hysterectomy?

The recovery time for a robotic hysterectomy is shorter than more traditional open hysterectomies. However, it is still an operation and the body does need time to heal properly. Most patients spend only 1-2 hours in the post-operative recovery unit and may leave the hospital the same day. If a little more time is needed, usually an overnight stay is sufficient and they leave the hospital the day after the operation. The patient then recovers at home for 6 days to two weeks, though bed rest is not necessary. There may be some level of discomfort and post-operative fatigue, but patients are encouraged to do non-strenuous walking and moving around. Heavy lifting over 20 pounds or any kind of intense physical activity is discouraged for the first few days.

Various medications for pain, nausea (following the anesthesia), and bloating will be prescribed. The patient may eat solid foods soon after the procedure and should drink plenty of water to stay hydrated and aid in the healing process. If the patient does not need narcotic analgesics, they may start driving within a few days. A post-operative check-up with the surgeon will be scheduled, usually within 1-2 weeks of the surgery. The patient should refrain from sexual intercourse for 8 to 10 weeks and a follow-up, non-invasive examination with the patient’s gynecologist should be performed approximately 6 weeks after the surgery.  

How long does it take to perform a robotic hysterectomy?

A robotic hysterectomy does not take longer to perform and typically can take anywhere from 45 minutes to 90 minutes. However, if a complete hysterectomy with a complex underlying condition has to be performed, the procedure may end up taking as long as 120 minutes.

Because the incision is considerably smaller for a robotic hysterectomy, the process of removing the uterus is significantly different than traditional open surgery or a vaginal hysterectomy. The surgeon, viewing the surgical site with the laparoscope and using the robotic instruments, cuts the uterus in to tiny pieces and removes them one-by-one via the vagina. This is the primary reason why the procedure actually takes longer, although the smaller incisions result in a much less invasive procedure.

What are the side effects of a robotic hysterectomy?

Robotic hysterectomies are very safe procedures, though all surgeries carry some measure of risk. Any operation may result in the risk of a post-operative infection, either at the incision site or a general bacterial infection of the skin or organs. There may be an abnormal development of scar tissue that turn in to growths known as keloids; these can cause discomfort or dysfunction in the internal organs as well as at the external incision sites. There may be internal hemorrhaging during the operation that, in extremely rare cases, may result in serious complications. Blood clots and thrombosis are also possible risks.

There is the slight chance that damage to the urinary tract may occur. This would most likely occur in the bladder, kidneys, or ureters, causing problems with urination or incontinence. GYN LA doctors are well trained to manage and prevent these injuries. If the ovaries are removed, sexual desire may decrease due to a lack of estrogen. However, hormone replacement therapy may effectively treat the condition and many women actually find that their sexual desire increases following the hysterectomy as they no longer suffer the negative symptoms associated with the underlying conditions. Some women find that they experience decreased lubrication during sexual intercourse following the operation; however estrogen creams and various lubricants can be used to treat this.

The anesthesia used in the procedure may cause various side effects, usually immediately following the operation. These include:

• Nausea
• Dizziness
• Temporary amnesia
• Confused thoughts
• Shivers
• Dry mouth
• Sore throat from the breathing tube

There is also the possibility that the patient may have an adverse reaction to the anesthesia. This is a more serious complication but is also exceedingly rare; anesthesiologists are trained to handle precisely these types of situations and are present throughout the entire duration of the surgery.

Find a Robotic Hysterectomy Practice Near Me

GYN LA is a Los Angeles-based gynecological medical practice that specializes in precisely these types of robotic surgeries. Our staff and team are trained to handle procedures at all risk levels and for patients with every kind of need. Our standard of compassionate, comprehensive, and cutting-edge care is of the highest caliber and we can help guide you through whatever medical needs you may have. Call 310-375-8446 today to speak to one of our specialists for a consultation.