What is a robotic hysterectomy?

Hysterectomy is the surgical removal of a woman's uterus. This surgery can be done through small incisions using a thin, lighted scope with a camera on the end (a laparoscope). This is called a laparoscopic hysterectomy.

In robotic-assisted laparoscopic hysterectomy, the surgeon uses a computer to control the surgical instruments. The computer station is in the operating room. The surgeon is able to control the robot's movements steadily and precisely. This lets him or her get into tiny spaces more easily and have a better view of the operation than with conventional laparoscopic surgery. This procedure continues to be researched to improve the technique.

Why might I need a robotic hysterectomy?

Your surgeon may recommend this surgery if you have a problem with your uterus that has not responded to other treatments. Here are some common reasons why a hysterectomy is recommended:

• Non-cancerous fibroid tumors

• Cancerous tumors

• Uterine prolapse (your uterus has slipped down into your vagina)

• Endometriosis (cells from the lining of your uterus grow outside your uterus, causing pain and bleeding)

• Other causes of long-term abnormal uterine bleeding

• Chronic pelvic pain

Some reasons why robotic-assisted laparoscopic hysterectomy may be recommended:

• You will have smaller incisions than in an open type of hysterectomy.

• You may have less pain and a shorter hospital stay after surgery.

• Your recovery may be easier.

• Your risk for complications like bleeding or infection may be less.

What are the risks of a robotic hysterectomy?

Robotic-assisted laparoscopic hysterectomy is a safe procedure, but all surgeries carry some risks. You will need to sign a consent form that explains the risks and benefits of the surgery. You will also want to discuss these risks and benefits with your surgeon. Some potential risks of hysterectomy done by any technique include:

• Reaction to the anesthesia

• Infection

• Bleeding

• Damage to other organs inside the abdomen

• Blood clots that form in your legs and may travel to your lungs

An additional risk of robotic surgery:

• Robotic-assisted laparoscopic surgery may take longer than other types of surgery. This means that you are under anesthesia longer. This may increase some of your surgical risks.

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I prepare for a robotic hysterectomy?

Sometime before the day of your surgery you will need a physical exam. Your surgeon may also order tests, such as blood tests, a chest X-ray, or an electrocardiogram (ECG) to check on your general health. Be sure to tell your surgeon about any medications you take at home, including herbal supplements and other over-the-counter medications. You may be told to stop taking aspirin or other medications that thins your blood and may increase bleeding.

Other points to go over:

• Tell your healthcare provider if you or someone in your family has any history of reaction to general anesthesia.

• If you smoke, you may have to stop smoking well before surgery.

• On the day and night before surgery you will be given instructions on when to stop eating and drinking. If you are having general anesthesia, it is common to have nothing to eat or drink after midnight or for at least 8 hours before surgery.

• Ask your surgeon if you should take your regular medications with a small sip of water on the morning of the procedure.

What happens during a robotic hysterectomy?

This surgery is usually done under general anesthesia.  So, you will be asleep during surgery. Before the procedure:

• You will have an intravenous line (IV) started so you can receive fluids and medications to make you relaxed and sleepy.

• If you are having general anesthesia, medication may be given through the IV to put you to sleep.

• A tube may be inserted in your throat to give you anesthesia and help you breathe while you are asleep.

• You may be given antibiotics before surgery.

• You may have a catheter tube placed into your bladder to drain urine.

• You may have special stockings placed on your legs to help prevent blood clots.

Surgery time may range from 3 to 4 hours.

This is what may happen during the surgery:

1. Three or 4 small incisions are made near your belly button.

2. Gas may be pumped into your belly to inflate it and give your surgeon a better view and more room to work.

3. The laparoscope is inserted into your abdomen. Other surgical instruments are inserted through the other incisions.

4. Your surgeon attaches the laparoscope and the instruments to the robotic arms of the computer.

5. Your surgeon moves to the control area to remotely control the surgery.

6. Your uterus is cut into small pieces that can be removed through the small incisions.

7. During laparoscopic-assisted vaginal hysterectomy your uterus may be taken out through your vagina.

8. Depending on the reasons for your hysterectomy, the whole uterus may be removed or just the part above the cervix. The tubes and ovaries attached to the uterus may also be removed.

9. After surgery, the incisions are closed with 1 or 2 stitches and covered with small dressings.

What happens after a robotic hysterectomy?

After surgery, you will be taken to the recovery room to be watched as you recover from the anesthesia. Most people stay in the hospital for a few days. During your hospital stay this is what may happen:

• Expect some pain after this procedure. You may be given pain medicine through your IV.

• Your IV will be removed once you can drink fluids and your bowels are starting to pass gas.

• You will be given additional pain medicine by mouth or by injection as needed.

• Once your IV is removed and you are passing gas, you can start a normal diet.

• Your bladder catheter will be removed in 1 or 2 days.

• You may have bleeding from your vagina that requires the use of pads.

• You will be encouraged to get up and walk as soon as you are able. This helps prevent blood clots from forming in your legs.

• You may be given medicine that also helps prevent blood clots.

• Caregivers will help you with your bathroom and wound care.

Once you go home, it’s important to follow all of your surgeon's instructions and keep your follow-up appointments. Take any medications as directed. Some pain during early recovery is normal. Ask your surgeon what medications to take for pain.

Here is what you can expect during recovery at home:

• You should be able to gradually return to your normal diet.

• Your incision areas should be kept dry for a few days. Follow your surgeon's instructions on bathing and dressing care. You may need to go back to have your stitches removed.

• Keep walking. You should gradually be able to resume normal activities in a few days.

• Avoid heavy lifting for a few weeks. Ask your surgeon when you can return to specific activities.

• You may continue to have light bleeding from your vagina for several days.

• You may be instructed not to put anything into your vagina for up to 6 weeks.

• Complete recovery may take anywhere from a few weeks to a few months.

Tell your surgeon about any of the following during recovery:

• Increasing pain or pain that is not relieved by medication

• Any drainage, bleeding, redness, or swelling from your incision areas

• Fever

• Heavy vaginal bleeding

• Pain or swelling in your legs

• Chest pain or shortness of breath

In addition to the physical symptoms of recovery, you may have emotional symptoms after this surgery. After hysterectomy you will no longer be able to get pregnant and your periods will stop. Some women experience sadness related to these losses.

If you have had your ovaries removed as part of your surgery, you may notice symptoms of menopause, such as hot flashes and vaginal dryness. Some women may benefit from hormone therapy after hysterectomy. Discuss this with your doctor.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• The risks and benefits of the test or procedure

• When and where you are to have the test or procedure and who will do it

• When and how will you get the results

• How much will you have to pay for the test or procedure

For more information go to www.riversidehealthcare.org/robotic-assisted-hysterectomy.html