Hysterectomy Surgical Options | Dr Steven A. Vasilev MD
For either a benign (non-cancerous) or malignant (cancerous) condition, surgery may be suggested to remove the uterus. This type of surgery is called a hysterectomy. For years and years, it was done through one large vertical or transverse (bikini cut) incision (cut). Today, these surgeries can avoid large incisions and be done in a “minimally invasive” fashion. We review all news for technologies and techniques to help you get the most advanced and safest surgery possible. The actual number of tiny minimally invasive incisions varies depending upon the complexity of the hysterectomy but can range from one to about six.
This page serves as a primer about robotic hysterectomy with attached news, views, and blog posts links for the latest information to the side or bottom of this page.
Why da Vinci Surgery?
The da Vinci System is a robotically-assisted device that allows the surgeon very precise surgical control while performing a hysterectomy. The da Vinci System has some of the following advantages:
- 3D High Definition magnified view inside your body
- Wristed instruments that bend and rotate even more than the human hand can
- This enhanced 3-dimensional vision and precision instruments allows very meticulous surgery
da Vinci potential benefits compared to traditional incisional hysterectomy:
- Lower complication rate1,2,3,4
- Shorter hospital stay1,2,3,4,5
- Less blood loss and less chance for a transfusion1,3,4,5
- Lower hospital readmission rate4, 5
da Vinci potential benefits compared to traditional laparoscopic hysterectomy:
- Lower complication rate1, 4, 6
- Shorter hospital stay1, 2, 4, 5, 6, 7, 8
- Less blood loss1, 2, 5, 8 & less chance of blood transfusion4, 9
- Less chance of surgeon having to give up and convert to open surgery2, 6
Risks of Hysterectomy
Hysterectomy, using any approach, can lead to injury to the ureters (ureters drain urine from the kidney into the bladder), vaginal cuff problems (scar tissue in vaginal incision, infection, bacterial skin infection, pooling/clotting of blood, incision opens or separates), injury to bladder (organ that holds urine), bowel injury, vaginal shortening, problems urinating (cannot empty bladder, urgent or frequent need to urinate, leaking urine, slow or weak stream), abnormal hole from the vagina into the urinary tract or rectum, vaginal tear or deep cut. However, most of these risks are generally lowered by robotic surgery because when the dissection gets tough the magnification of the optics system allows a closer microscopic look at the tissues, helping avoid trouble.
- Ho C, Tsakonas E, Tran K, Cimon K, Severn M, Mierzwinski-Urban M, Corcos J, Pautler S. “Robot-Assisted Surgery Compared with Open Surgery and Laparoscopic Surgery: Clinical Effectiveness and Economic Analyses.” Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2011 Sep.
- Landeen, Laurie B., MD, MBA, Maria C. Bell, MD, MPH, Helen B. Hubert, MPH, PhD, Larissa Y. Bennis, MD, Siri S. Knutsten-Larsen, MD, and Usha Seshari-Kreaden, MSc. “Clinical and Cost Comparisons for Hysterectomy via Abdominal, Standard Laparoscopic, Vaginal and Robot-assisted Approaches.” South Dakota Medicine 64.6 (2011): 197-209. Print.
- Geppert B, Lönnerfors C, Persson J. “Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.” Acta Obstet Gynecol Scand. 90.11 (2011): 1210-1217. doi: 10.1111/j.1600-0412.2011.01253.x. Epub.
- Lim, Peter C., John T. Crane, Eric J. English, Richard W. Farnam, Devin M. Garza, Marc L. Winter, and Jerry L. Rozeboom. “Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications.” International Journal of Gynecology & Obstetrics 133.3 (2016): 359–364. Print.
- Martino, Martin A., MD, Elizabeth A. Berger, DO, Jeffrey T. McFetridge, MD, Jocelyn Shubella, BS, Gabrielle Gosciniak, BA, Taylor Wejkszner, BA, Gregory F. Kainz, DO, Jeremy Patriarco, BS, M. B. Thomas, MD, and Richard Boulay, MD. “A Comparison of Quality Outcome Measures in Patients Having a Hysterectomy for Benign Disease: Robotic vs. Non-robotic Approaches.” Journal of Minimally Invasive Gynecology 21.3 (2014): 389-93. Web.
- Scandola, Michele, Lorenzo Grespan, Marco Vicentini, and Paolo Fiorini. “Robot-Assisted Laparoscopic Hysterectomy vs Traditional Laparoscopic Hysterectomy: Five Metaanalyses.” Journal of Minimally Invasive Gynecology 18.6 (2011): 705-15. Print.
- Wright, Jason D., Cande V. Ananth, Sharyn N. Lewin, William M. Burke, Yu-Shiang Lu, Alfred I. Neugut, Thomas J. Herzog, and Dawn L. Hershman. “Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease.” Jama 309.7 (2013): 689-98. Print.
- Orady, Mona, Alexander Hrynewych, A. Karim Nawfal, and Ganesa Wegienka. “Comparison of Robotic-Assisted Hysterectomy to Other Minimally Invasive Approaches.” JSLS, Journal of the Society of Laparoendoscopic Surgeons 16.4 (2012): 542-48. Print.
- Rosero, Eric B., Kimberly A. Kho, Girish P. Joshi, Martin Giesecke, and Joseph I. Schaffer. “Comparison of Robotic and Laparoscopic Hysterectomy for Benign Gynecologic Disease.” Obstetrics & Gynecology 122.4 (2013): 778-86. Print.
- Inpatient data: Agency for Healthcare, Research and Quality (AHRQ). Outpatient data: Solucient® Database – Truven Health Analytics. da Vinci data: Intuitive Surgical internal estimates. 2014