Abdominal Hysterectomy | Da Vinci Robotic Surgery | Dallas

Over 600,000 hysterectomy procedures are performed each year in the United States. Seventy-five percent of these procedures involve an abdominal hysterectomy, which is performed with an incision running 6 to 12 inches across the abdomen. This technique typically results in a hospital stay of several days followed by a 6 to 8 week recovery period, in addition to a 6 to 12 inch scar running across the lower abdomen.

Luckily, for a woman requiring a hysterectomy procedure, this does not have to be the case any longer thanks to the Da Vinci Surgical System, developed by Intuitive Surgical. When performing a Da Vinci Robotic Surgery, gynecologists are now able to utilize a much less invasive procedure while maintaining a high level of precision.

Dr. Dennis Eisenberg, a Dallas-based gynecologist agrees.

"The Da Vinci Robotic Surgery," says Eisenberg, " has proven to be extremely effective. It makes procedures easier for me, as well as less invasive for the patients, both for their bodies and their aftercare. With all that goes into a hysterectomy, the Da Vinci Surgical System makes it better for everyone involved."

A hysterectomy procedure is used to treat a number of gynecological conditions including endometriosis, uterine fibroids, uterine prolapse, several types of cancer and uterine disease. There are several different types of hysterectomy procedures. A total hysterectomy requires the complete removal of the uterus, the fundus, and the cervix, while a partial hysterectomy will leave the cervical stump. Finally, radical hysterectomies are used to treat various gynecological cancers, among other conditions. In radical hysterectomy procedures, a surgeon will remove the cervix and the uterus, as well as the fallopian tubes, pelvic lymph nodes, ovaries, and possibly part of the vagina depending on the spread of the gynecological cancer.

As previously mentioned, most often a hysterectomy procedure will involve an abdominal hysterectomy. The reason an abdominal hysterectomy is so widely used is that a large incision in the abdomen will allow surgeons to see the entire area and better facilitate the removal of the uterus as well as any other affected organs such as the cervix or ovaries.

An abdominal hysterectomy will give surgeons greater dexterity with their hands as well as their surgical instruments. If any other conditions or problems are discovered during an abdominal hysterectomy, these issues are easily addressed during the surgery.

While an abdominal hysterectomy is the most common method of hysterectomy, there are several potential drawbacks to the procedure. The risk of complications is higher, and the procedure itself can be extremely painful and strenuous for the patient as well as for the surgical team. In addition, an abdominal hysterectomy will result in more scarring.

Complications from an abdominal hysterectomy can include excessive bleeding, blood clots, and damage to other abdominal organs such as the bowels or bladder. There is a higher risk of infection from an abdominal hysterectomy than in a less invasive hysterectomy procedure.

The hospital stay after an abdominal hysterectomy usually lasts one to two days, however this could be as long as four days. The recovery period after the procedure is usually six to eight weeks. During recovery, activity is severely limited with patients slowly returning to normal life over time.

It is possible for a less invasive hysterectomy procedure to be performed, such as a laparoscopic hysterectomy, which only requires a few small incisions, or a vaginal hysterectomy, which does not require any incisions on the abdomen at all.

According to Dr. Eisenberg, "these hysterectomy procedures, as performed traditionally, do not allow the surgeon as great a view of the affected area, and further limit the dexterity of the surgeon during the procedure. In addition, these procedures are only for minor conditions such as fibroids and are not practical for a condition such as gynecological cancer. If anything else is found during the procedure, the surgeon will more than likely have to revert to an abdominal hysterectomy."

While a Da Vinci hysterectomy is technically a laparoscopic hysterectomy procedure, a Da Vinci Robotic Surgery is significantly different from previous laparoscopic methods.

The Da Vinci Surgical System is a two-part system developed by Intuitive Surgical. The system contains a surgical console set up separately from a patient cart. The patient cart is equipped with four robotic arms that actually perform the surgery while a surgeon will sit at the console controlling the arms with pressure sensitive controls that replicate the exact movements of the surgeon. The controls are able to provide extremely precise and dexterous movements, while a tremor reduction system minimizes the effects of unintended hand movements, meaning that the Da Vinci’s robotic arms can provide more precise movement than an actual human hand.

While the surgeon is across the room at the console, he or she can have an excellent view of what they are doing with a highly magnified fully three-dimensional image provided by a 3D camera on the patient cart. This means that, hypothetically, the surgeon does not even have to be in the same room as the patient. While this is not what a Da Vinci Robotic Surgery was intended for, it goes further to show the effectiveness of the system and the possibilities that could be achieved with such a robotic system.

The entire system is designed in such a way as to significantly reduce the fatigue of the surgeon and support staff. The surgeon no longer has to worry about positioning instruments and is seated comfortably for the entire procedure. Most of what the support staff now does is limited to switching the instruments on the robotic arms. With the reduced stress and fatigue, the surgical team is able to provide more effective care for patients.

The Da Vinci Surgical System is used in the following procedures: cardiothoracic procedures, sacrocolpopexy procedures, myomectomy procedures, hysterectomy procedures, urologic procedures, and other less invasive general surgery procedures.

A Da Vinci Robotic Surgery has proven to be a far less difficult hysterectomy procedure than a traditional abdominal hysterectomy. The procedure does everything that a traditional abdominal hysterectomy would do but uses several 1 to 2 centimeter long incisions, rather than one larger incision. This results in far less scarring.

Other benefits of a Da Vinci Hysterectomy include a diminished risk of complications and infection, and a less intensive hospital stay and recovery time. Many patient cases have resulted in better outcomes due to the precision that results from a Da Vinci Robotic Surgery.

Recovery times after a Da Vinci Robotic Surgery are significantly reduced, with many patients recovering in as short as one to two weeks, with only a few activity limitations after that period.

"I have found," says Dr. Eisenberg, "that I am able to achieve an amazing precision using the Da Vinci Surgical System. This goes further in providing my patients with a much more comfortable experience during and after surgery.”

There are a wide variety of gynecological conditions that are treated surgically.

Endometriosis, a condition that occurs somewhat frequently in women during their childbearing years, results in the uterine lining, or endometrium, growing outside of the uterus. The endometrium will thicken with menstruation, however, as the tissue is growing outside of the uterus in the body, there is no place for the uterine lining to escape when it breaks down, resulting in inflammation and scars around the affected areas. The situation is further worsened as time progresses, with each menstrual cycle adding more endometrium, which breaks down and more blood collects in the body with no means of escape. This growth of endometrium will increase the severity of the symptoms of endometriosis, causing further discomfort.

Endometriosis treatment consists of a variety of methods including hormone therapy and surgeries. Laparoscopic surgery is used to remove uterine lining growing outside of the uterus and to enable the patient to still possibly bear children. In more serious cases, endometriosis treatment will require the uterus to be removed with a hysterectomy procedure.

In addition to the aforementioned conditions, hysterectomies are used in response to several different types of cancer. Endometrial cancer, also known as uterine cancer, affects the uterine lining, or endometrium. Endometrial cancer occurs when the uterine lining begins to thicken without leaving the uterus. Treatments include a hysterectomy procedure to remove the uterus.

Cervical cancer, which occurs when cells in the cervix begin to uncontrollably grow, is often treated surgically. This will require removal of the pelvic lymph nodes during a hysterectomy procedure.

Finally, tumors growing on the ovaries can mean a diagnosis of ovarian cancer, which can be treated surgically. In addition to the ovaries, the uterus may have to be removed as well. After surgery, chemotherapy is used to kill any remaining cancer cells.

Uterine fibroids are tumors that grow on the outside, the inside, or in the wall of the uterus. While uterine fibroids occur quite frequently in women, with 80% of women developing them, uterine fibroids are most often benign, in fact less than 0.1% of uterine fibroids prove to be cancerous, or less than one in 1,000.

While most women with uterine fibroids do not experience any symptoms, those that do can be subjected to extremely uncomfortable symptoms. Uterine fibroid symptoms include painful periods with excessive bleeding, fullness in the abdomen, and lower back pains. Some women with uterine fibroids experience problems with sexual function and satisfaction. In addition, uterine fibroids can often cause reproductive problems such as infertility, which is rather rare, as well as other problems during pregnancy.

Once uterine fibroids are diagnosed, many women will not need treatment as most do not experience any discomfort from the condition. However, those women that do have discomfort from uterine fibroids do have several options for treatment. These options include over-the-counter medications to relieve pain, and birth control pills to lighten periods. For some more serious cases, surgery is often recommended. These surgeries include a myomectomy for women still wanting to have children, or a hysterectomy for women either past their child bearing years or who no longer want to have children.

One of the biggest consequences of a hysterectomy procedure is that it eliminates the possibility of a woman having children after undergoing the procedure. The reason for this is that most if not all the necessary structures for reproduction will be removed in the hysterectomy procedure. Because of this, women who have a uterine fibroid problem, but still might want to have children, should consider a less limiting procedure known as a myomectomy.

A myomectomy is a surgical procedure that only removes the uterine fibroids, while keeping the uterus and other reproductive structures intact. This allows women who undergo the procedure to still possible bear children.

A myomectomy is performed with either an open incision in a laparotomy, or with smaller abdominal incisions in a laparoscopy. As the procedure does use the same methods as a laparoscopic hysterectomy procedure, it does carry the same inherent drawbacks.

A myomectomy procedure can also be performed using the Da Vinci Surgical System. During a Da Vinci Robotic Surgery, a surgeon can achieve a remarkable level of precision in a myomectomy, and even in uterine reconstruction after the fibroids have been removed. This precision is extremely important in preventing uterine rupture during any possible future pregnancies.

The number of surgeons performing the Da Vinci Robotic Surgery procedure is growing as the procedure proves itself to be both safe and effective. Women are increasingly requesting the Da Vinci technique as well, due to the reduced invasiveness and post-surgery discomfort. The Da Vinci system allows the surgeon to easily achieve a much higher level of precision in a less invasive procedure while allowing the surgeon to maintain a high level of comfort. This will reduce the stress on a patient undergoing the procedure as well as further minimize the difficulties of recovery.

“Women now have a less invasive alternative to the traditional abdominal hysterectomy,” concludes Dr. Dennis Eisenberg, “and as the clinical data continues to prove the effectiveness and safety of the technique, I think you will see more and more women choosing Da Vinci and having a much more manageable and faster recovery from surgery, returning to work and activities in a fraction of the traditional time frame.”