By Geoffrey Bowers, MD, Virtua Gynecologist/Robotic Surgeon
Section Chief, Gynecology, and Medical Director, Robotic Surgery—Virtua South

If you have pain and heavy bleeding caused by uterine fibroids or endometriosis, a hysterectomy (surgical removal of the uterus) often is your only option for symptom relief. While it’s hard enough to face the thought of surgery, coping with a potentially lengthy recovery time can make it worse. 

The advantage for women is that advances in robotic technology have made hysterectomies safer and less invasive.

Benefits for patients who undergo single-incision robotic hysterectomies include shorter recovery times, less discomfort, minimal need for pain medications, less blood loss, and little, if any, scarring. Patients also have a low risk of complications associated with blood loss or infection.

What is the “robot” in robotic hysterectomy?

During a robotic hysterectomy, the surgeon uses a state-of-the-art robotic surgical system. But this doesn’t mean the robotic system does the surgery.

This system has multiple “wristed” robotic arms that hold surgical instruments. These arms allow the surgeon to make precise, delicate movements in small spaces. Because the “wrists” on the robotic arms rotate a full 360 degrees, they offer more dexterity than the human hand. 

One of the robotic arms holds a tiny 3D, high-definition video camera. This camera transmits up-close video of the surgical area to a screen on the system’s control console.

During the procedure, the surgeon maintains complete control of the robot at all times. Sitting at the control console, the surgeon maneuvers the robotic surgical instruments, using the real-time video as a guide.

How is a robotic hysterectomy performed?

To begin, the surgeon makes a small incision on the inside rim of the belly button. In 90 percent of cases, the hysterectomy can be performed through this one incision. However, some cases require three or four additional small incisions in the abdomen to accommodate other surgical instruments.

After making the incision, the surgeon uses the robotic arms to insert the video camera and surgical tools. Using the 3D video for guidance, the surgeon maneuvers the surgical instruments with the robotic arms to detach the organs from the surrounding tissues.

One question the surgeon always gets—how do you remove the uterus and other organs through a one-inch incision? After the surgeon detaches the uterus, it’s removed from the body through the vagina. Removing the organs this way reduces the risk of complications associated with major abdominal surgery and other complications that can result from destroying tissues within the abdominal cavity.

Robotic technology is used to perform total hysterectomies (removing the uterus and cervix) or partial hysterectomies (removing only the uterus). Single-incision robotic hysterectomies typically take between one-and-a-half to two-and-a-half hours. Surgeries requiring multiple incisions may take longer.

How long is the recovery period?

Most robotic hysterectomy patients return home the day of their surgery, after a two- to three-hour recovery period. Patients regain mobility within one day of surgery. Ninety percent of patients return to light physical activity and driving within a week and return to desk jobs after two weeks.

Even though patients may feel better quickly, it’s important to remember that full recovery takes between four to six weeks. To allow the internal sutures to heal during this recovery, patients shouldn’t insert anything into the vagina or have sex. Patients also should avoid heavy lifting for four to six weeks.

How is a robotic hysterectomy different from a laparoscopic or traditional procedure?

A traditional open hysterectomy requires a five- to seven-inch incision in the abdomen and a two- to three-day hospital stay. In addition to a longer recovery time, patients who undergo a traditional open hysterectomy have visible scarring, increased pain, and a higher risk of complications, such as infection at the incision site.

A laparoscopic (minimally invasive) hysterectomy is performed through three or four small incisions in the abdomen. This procedure is less invasive than a traditional open hysterectomy and gives the surgeon a 2D view of the surgical area. Laparoscopic surgical instruments are different in that they don’t provide the same full range of motion as the “wristed” robotic arms.

To see if a robotic hysterectomy might be right for you, call 844-896-6367 to schedule a consultation with a robotic surgeon who specializes in gynecologic surgery.