A hysterectomy is a surgical procedure to remove a woman's uterus. If you need a hysterectomy, you may be a good candidate for a robotic procedure, which offers several advantages over other surgical methods.
In the videos below, Dr. Heath Miller describes the robotic hysterectomy procedure and its benefits.
Hysterectomy is often part of the treatment plan for women with gynecological cancers, including:
- Endometrial (uterine) cancer
- Cervical cancer
- Ovarian cancer
Also today, more women with a personal history of breast cancer or a family history of ovarian cancer consider having a hysterectomy prophylactically – before any signs of cancer appear.
For benign conditions and chronic complaints that cannot be controlled by other means, hysterectomy is often the best treatment choice. These include:
- Uterine fibroids
- Uterine prolapse
- Chronic pelvic pain
The term "hysterectomy" can cause confusion, because more than the uterus is sometimes removed. The type of surgery a woman needs depends on her condition – whether cancerous or benign, and how advanced a condition might be.
Types of hysterectomy include:
- Partial hysterectomy: removes the uterus without removing the cervix (also referred to as a supra-cervical hysterectomy)
- Total hysterectomy: also called "complete" or "simple" hysterectomy, this is the removal of the uterus and the cervix
- Hysterectomy with salpingo-oophorectomy: the removal of the ovaries and fallopian tubes during a hysterectomy
- Radical hysterectomy: typically done only for certain cancer patients, may remove all of the above, plus part of the vagina
Traditionally, hysterectomies have been performed as an "open" procedure: the surgeon makes a long incision across the abdomen to gain access to the uterus.
Other techniques include vaginal hysterectomy and laparoscopic hysterectomy. Not everyone is a candidate for vaginal hysterectomy, and laparoscopic hysterectomies can be difficult to learn how to perform, and so are not widely available.
In the U.S., 60 percent to 70 percent of hysterectomies are still done as open procedures. At Swedish, only about 20 percent of hysterectomies are now done this way. That's because Swedish surgeons have the skills and experience to consistently have good outcomes with robotic surgery.
Benefits to our patients include:
- A short hospital stay – typically overnight
- Moderate pain that is resolved in three to five days
- A quick recovery of one to two weeks
- Much less risk of post-surgical infection
- Minimal scarring
In comparison, patients who have an open hysterectomy are in the hospital two to four days, experience significantly more pain while healing and take up to six to eight weeks to recover completely.
Robotic procedures are done in an operating room with a specially trained surgical staff. Patients are under general anesthesia, and are constantly monitored by an anesthesiologist.
During the procedure:
- The surgeon makes three to five incisions in the abdomen, each five to 12 millimeters long
- The abdomen is inflated with carbon dioxide gas to give the surgeon space to work
- Specially designed surgical instruments and a tiny camera are attached to robotic arms and precisely inserted through the incisions
- The surgeon then sits at a nearby console and controls every movement of the robotic arms
- The surgeon then detaches the uterus – and possibly, the cervix, ovaries, and fallopian tubes – from the ligaments and structures that hold it in place
- A lymph node dissection can also be performed if cancer is suspected
If both the uterus and the cervix are detached, they can be removed through the vagina.
If the cervix is left in place – an option some women with benign conditions consider – the uterus can be removed through one of the small incisions using specialized instrumentation.
Once the uterus is removed, the surgical instruments are removed and the incisions closed.
All surgeries involve some degree of risk, and discussing this with your doctor is an important part of preparing for any surgery.
Complications from robotic hysterectomy are uncommon.
In comparison, because of the large incision, the risk from an open hysterectomy include an increased risk of post-surgical infection, blood clots in the legs (deep-vein thrombosis) and scar tissue that may interfere with fertility.
Robotic surgical systems are now widely available. That does not mean every robotic surgeon has the skill and experience to perform robotic surgery with good outcomes. It's crucial to choose your surgeon wisely.
Swedish has some of the most experienced robotic surgeons in the country performing robotic hysterectomies. They have been performing robotic surgeries since 2005, and currently do more than 600 robotic hysterectomies every year.
When you interview surgeons you are considering, be sure to ask:
- How long has robotic surgery been available at the hospital?
- How many robotic surgeries of all types are done there?
- How long has the surgeon been performing robotic hysterectomies?
- How many robotic hysterectomies has he/she done?
Swedish is a regional center for performing – and teaching – robotic surgery. More than 4,000 robotic procedures have been performed here and everyone on our robotic surgery teams is specially trained and highly experienced. Our surgeons publish and lecture widely, and train other physicians from around the country.