Not every woman is a candidate for a da Vinci robotic hysterectomy.
But, if you are, it can have many advantages, especially over an abdominal hysterectomy.
There are many types of hysterectomies, from abdominal hysterectomy to vaginal hysterectomy, to laparoscopic vaginal hysterectomy.
A newer type of hysterectomy is the robotic hysterectomy.
So how do you know you if are eligible for a da Vinci hysterectomy?
It seems an ideal solution for women that prefer a quick recovery and minimal scarring.
You may ask yourself what happens during a robotic hysterectomy and if there are no downsides to this type of surgery.
What is a da Vinci robotic hysterectomy?
A robotic-assisted hysterectomy makes use of a laparoscope, which is a flexible or straight tube that has a tiny camera on the end of it and the means to blow gas into the abdominal and pelvic space to see the structures better.
Then they make very small incisions in the abdomen and pelvic area for the laparoscope to enter as well as for tools like electrocautery, suturing tools, trocars, and scissors to do the surgery.
During robot surgery, the surgeon does not actually see your uterus and surrounding tissues. Instead, images of these structures are visible on a screen that is suspended over the surgery. Along with a computer that uses robotic technology. This allows them to precisely make the correct cuts inside your pelvis so they can remove the uterus from your body.
The robotic features allow the surgeon to reach the uterus so that a better view of the uterus can be made at the time of surgery.
Who can have a robotic hysterectomy?
If you have difficulties with your uterus that interferes with daily living to such a degree than your doctor may recommend removal of the uterus. In this case, you may like to know if you are a candidate for a robotic-assisted hysterectomy.
Some indications for robotic hysterectomy include the following:
- Cancer of the uterus
- Prolapse of the uterus, where it is sagging into the vaginal vault
- Fibroid tumors of the uterus, which are non-cancerous tumors
- Abnormal vaginal bleeding
- Endometriosis, in which cells from the uterine lining are growing outside the uterus itself, implanting into nearby structures instead
Main advantages of da Vinci robotic hysterectomy
The main advantages of having a robotic hysterectomy are that they make small incisions in the abdominal wall so your recovery time is much less than with an open abdominal hysterectomy. Your stay in the hospital will be much shorter and you will get back to your normal routine faster than with an open surgery. The risk of infection and bleeding complications are less than with an open hysterectomy.
The disadvantages of a robotic hysterectomy
There are risks to having robotic surgery. Some of these risks include those found in any surgery. Risks like bleeding, infection, organ damage to other pelvic and abdominal organs, and anesthesia complications. A da Vinci robotic hysterectomy tends to take a longer period than other types of surgery so the anesthesia risks are slightly greater.
Other issues you may want to consider:
- The robotic system has a complex user interface, making it for some surgeons hard to learn to use the device. To lower your risk of complications, take some time to investigate how much experience your surgeon has with the da Vinci robot.
- It is also possible that during the operation the surgeon needs to convert to another technique and make a larger abdominal incision.
- Note that, with a da Vinci robotic hysterectomy there is not only the risk of human error, but there is also a chance mechanical failure of the equipment. Malfunction of the robot’s arm, malfunction of the camera and problems with the computer’s software are highly uncommon but have been reported.
- In 10% of robotic surgeries, they use a power morcellator. They use this device to cut a uterus into smaller pieces if it is too big to remove it through the vagina. Or if it cannot fit through the tiny incisions in the abdomen. But the device can also spread undiagnosed uterine cancer. this can happen when fragments of malignant tissue stay in the abdominal cavity and attach to other internal organs.
According to the FDA, 1 in 350 women that need a hysterectomy for fibroids, suffers from undiagnosed uterine cancer. Before robotic surgery, your physician has to explain the risks of using a power morcellator and they may ask you to sign a morcellation consent form.
The da Vinci robotic hysterectomy procedure itself
When undergoing a robotic hysterectomy, you will receive an IV for anesthesia and fluids. You will also have a bladder catheter to drain urine to keep the bladder out-of-the-way during surgery. If they put you under general anesthesia, you will have an endotracheal tube put down your throat to breathe for you while you are in surgery.
You may need compression stockings to prevent blood clots from developing in the deep veins of the calf. This is the danger of prolonged immobility.
The surgery itself will take about 3-4 hours, during which you will be asleep. They start by making 3-4 incisions, with one of the incisions being just beneath the belly button (umbilicus). Then they inject gas into the abdomen to highlight the organs better.
The laparoscope is then inserted into the abdominal and pelvic space and the robotic instruments go into some of the other incisions. The surgeon uses a remote control device that will separate the uterus from its surrounding pelvic structures.
Once free, they can either remove the uterus through the vagina in one piece or cut it into several small pieces (morcellated). At the end of the surgery, they close the incisions with a couple of dissolvable stitches or staples.
They remove the bladder catheter once you are up and about and can use the restroom yourself. You may stay in the hospital for 1-2 days after surgery. You can usually drive within a week of surgery. Most women feel relatively well without the need for pain medications after about two weeks.
Da Vinci hysterectomy recovery
Here is some advice for the recovery period at home.
For the first weeks, prefer a shower over a having a bath in the tub. Soaking in water does not promote the healing of your wounds (inside and outside) and increases the risk of infection.
Some women are under the impression that with minimally invasive surgery they can resume having sexual intercourse sooner than with abdominal surgery. But, even with a da Vinci robotic hysterectomy, you have to wait at least 6 weeks. That is the time the inner wound at the top of the vagina needs to heal.
When can you get back to work? This depends mostly on how you feel. Some women are able to return to their job after 2 weeks. But others need 4 weeks before they feel ready to go back.
If your work requires physical effort you better wait a bit longer. Even if you feel great, please remember, you are not supposed to do any heavy lifting for at least 6 to 8 weeks.
Remember, not to lift too much weight before the top of the vagina has healed. Internal stitches can rip loose and you will need emergency surgery to re-stitch the vaginal cuff.
Please feel free to share your experience of a da Vinci robotic hysterectomy in the comments.