Robotic hysterectomy offers a less invasive surgical option compared to traditional methods. While half a million hysterectomies are performed annually in the United States, approximately 65% of these surgeries are performed using minimally invasive methods. Robotic surgery, in particular, speeds up the recovery process by providing the surgeon with a three-dimensional view and precise mobility. In this article, we will explain topics such as what robotic benign hysterectomy is, when it is applied, how the surgical process works, and what you need to pay attention to after robotic hysterectomy surgery.
What is Robotic Benign Hysterectomy?
Uterine removal surgery is medically known as a hysterectomy. Robotic benign hysterectomy is the procedure of removing the uterus using robotic surgery due to non-cancerous, i.e., benign diseases of the uterus. This surgery is performed by the surgeon sitting at a special console and managing the robotic arms.
How does the robotic surgery system work?
The da Vinci robotic surgery system consists of three main components in the operating room. The patient-side cart consists of four arms and is positioned next to the patient. One of these arms is attached to the camera, and the other three are attached to surgical instruments. The surgeon console is the actual control center of the surgery. Sitting at this console, the surgeon controls the arms of the robot with hand controls. The vision tower is the area where the endoscope is attached and the system's processor is located.
The system instantly transfers the surgeon's movements to the robotic arms. Thanks to foot pedals, the surgeon controls the camera and can zoom in on the surgical view as desired. The three-dimensional camera system provides images with a sense of depth and shows a magnified view of the surgical area up to 10 times. The robot arms can rotate up to 540 degrees, mimicking the human wrist. This feature makes it possible to perform precise interventions even in narrow and deep areas.
The robotic system filters out even the smallest vibrations in the surgeon's hand and prevents them from reflecting onto the operating field. Thus, delicate structures such as blood vessels and urinary tracts can be distinguished much more clearly.
Differences from traditional methods
In open surgery, the surgeon makes a large incision to reach the uterus. In laparoscopic surgery, the surgery is performed with long instruments through small holes. Robotic surgery is an advanced version of the laparoscopic method. While the surgeon watches a two-dimensional image on the screen in laparoscopy, robotic surgery provides a three-dimensional high-definition image.
In laparoscopic surgeries, instrument movements are at limited angles. In the robotic system, the arms provide more flexibility than the human wrist. In addition, while the surgeon's hand tremor in laparoscopy is directly reflected in the surgical area, the robotic system completely eliminates this tremor.
Advantages of Robotic Hysterectomy Surgery
Robotic hysterectomy surgery offers significant advantages over traditional methods. Less blood loss is experienced thanks to small incisions. The sensation of postoperative pain is much less. The risk of infection decreases and wound healing time shortens. The length of hospital stay is significantly reduced.
The ability of the surgeon to work while sitting prevents fatigue in long surgeries and ensures maximum efficiency. The ability of the robotic arms to be exposed to high disinfection processes creates a more sterile environment. Patients return to their normal activities faster with this method and regain their social lives in a short time.
When is Robotic Benign Hysterectomy Performed?
Robotic benign hysterectomy surgery is preferred in the treatment of various benign diseases occurring in the uterus. This method comes to the agenda when other treatment options are insufficient.
Fibroid treatment
Fibroids are the most common reason for robotic hysterectomy applications worldwide. Fibroids are benign tumors that develop in the muscular layer of the uterus. While small fibroids usually do not cause complaints, large fibroids can lead to serious problems. Intervention is required when excessive bleeding, severe pain, abdominal pressure sensation, and infertility problems are experienced. Since fibroids cannot be treated with medication, the removal of symptom-causing fibroids or the complete removal of the uterus may be in question. Robotic surgery provides successful results by offering precise intervention in this case.
Excessive menstrual bleeding
Uncontrolled heavy menstrual bleeding constitutes an important indication for robotic hysterectomy. When hormonal treatments and medications do not work, bleeding seriously reduces a woman's quality of life. Problems such as anemia, fatigue, and withdrawal from social life occur. Robotic hysterectomy is the most effective but last resort surgical option in the treatment of menorrhagia. The decision is made by evaluating the patient's age, future childbearing plans, and the severity of the bleeding.
Chronic pelvic pain
Groin pain that lasts longer than six months and does not resolve with medications is defined as chronic pelvic pain. This condition constitutes approximately 10% of applications to gynecology outpatient clinics and 12-16% of hysterectomy indications. Robotic hysterectomy becomes an option in chronic pelvic pain cases that cannot be resolved with drug treatments or other surgical methods. By eliminating the source of the pain, the patient's quality of life is significantly increased.
Endometriosis
Defined as the growth of the uterine lining tissue outside the uterus, endometriosis can lead to severe pain and infertility. When hormonal treatments and other methods are insufficient, robotic hysterectomy can be performed. Especially if adenomyosis is also present, the removal of the uterus increases the benefits of the surgery. However, it is essential that endometriosis lesions are removed by an expert team. Simply removing the uterus and leaving other lesions behind is not a correct approach.
Uterine prolapse
The slipping of the uterus towards the vagina as a result of the weakening of pelvic floor muscles and ligaments is known as uterine prolapse. It is more common in women who have had multiple births or are postmenopausal. It causes symptoms such as urinary incontinence, pelvic pain, and vaginal pressure sensation. In advanced cases, robotic hysterectomy offers the most effective solution. Interventions performed with robotic surgery reduce the patient's recovery time from 6-8 weeks to 3-4 weeks.
Who is it a suitable option for?
Robotic hysterectomy surgery is particularly suitable for specific patient groups. Patients with obesity, patients with advanced endometriosis or pelvic adhesions, and patients with endometrial cancer benefit best from this method. In addition, the robotic system provides significant advantages in cases with complex surgical cases and requiring delicate intervention in the narrow pelvic region.
How is Robotic Hysterectomy Surgery Performed?
Every stage of the surgical process is meticulously planned and patient safety is always a priority. Robotic benign hysterectomy surgery is carried out with a professional team from preoperative preparation to discharge.
Preoperative preparation
Your doctor makes a comprehensive evaluation after deciding on surgery. Your general health status is checked with physical examination, blood, and urine tests. Your suitability for anesthesia is evaluated by taking a chest X-ray and electrocardiography. You will be informed which of the medications you use should be continued and which should be stopped before surgery.
Clear instructions are given on when to stop eating and drinking the night before and the morning of the surgery. You are usually asked to fast starting 6 hours before surgery. In some cases, an enema may be required for bowel preparation. Your surgeon explains the procedure in detail, including potential complications and side effects, and answers your questions.
What happens during the surgery?
On the day of surgery, the patient is placed in the gynecological examination position. A urinary catheter is inserted to empty your bladder, and your abdominal area is cleaned with a sterile solution. An intravenous catheter is placed in your arm to deliver medications and fluids.
After general anesthesia is applied, the surgeon makes four or five small incisions in your abdomen. First, an incision of approximately 8 millimeters is made at the belly button, and the inside of the abdomen is inflated with carbon dioxide gas. Then, incisions are opened from other locations suitable for the robot's arms and trocars are placed. The arms of the robotic system are inserted into the abdomen through these trocars. One of these arms carries the camera providing high-definition three-dimensional images, while the others carry surgical instruments.
While the surgeon sits at the computer console, they control the precise movement of the robot arms, surgical instruments, and camera. Members of the surgical team stand next to the operating table to replace robotic instruments and provide assistance to the surgeon when necessary. The uterus is usually removed through the vagina, but in some cases, it can also be removed through small incisions in the abdomen. The anesthesiologist monitors your anesthesia and vital signs throughout the surgery.
Duration of surgery and technical details
The completion of robotic benign hysterectomy surgery takes one to four hours depending on the surgeon's expertise and the complexity of the surgery. Total hysterectomy operations take longer than operations where only the uterus is removed.
First hours after surgery
After the surgery is over, patients are usually discharged within 24 hours. As the effect of anesthesia begins to wear off, it is normal for pain to start in the surgical area and it is controlled with painkillers recommended by the doctor. The first walk is performed with the assistance of a nurse approximately 6-8 hours after the surgery. Early mobilization is critical for the initiation of bowel movements and the prevention of the risk of blood clots. Feeding with liquid foods begins after bowel sounds are heard, and a normal breakfast is usually transitioned to the next morning.
Risks and Benefits of Robotic Benign Hysterectomy
Knowing what situations you may encounter in the postoperative period helps you make the right decisions. Robotic benign hysterectomy surgery has both benefits and risks.
Benefits provided by surgery
Uterine removal surgeries performed with the robotic method bring significant advantages for patients. Blood loss during surgery is reduced by 50-70%. Thanks to the intervention performed with small incisions, postoperative pain is much less. Tissue damage remains at a minimal level and the wound healing process accelerates.
The length of hospital stay is significantly shortened. Most patients stay in the hospital for one night after surgery, and some patients can be discharged on the same day. The risk of infection remains at low levels. Cosmetic results are quite good since the incisions are a few millimeters in size.
The recovery time to daily life is significantly shortened. You can return to your normal activities within a two-week period. Movements such as sitting, getting up, and walking are easier to perform. However, complication rates are lower compared to traditional methods.
Possible risks and complications
As with any surgery, there are some risks in robotic hysterectomy surgery. Bleeding may occur during or after surgery. Rarely, a blood transfusion or additional surgical intervention may be required. There is a possibility of developing an infection in the surgical area.
Robotic surgeries take longer than traditional methods. Long surgery times can increase the risk of complications. However, when performed by an experienced team, these risks are minimized.
Comparison with open surgery
There are significant differences between robotic and open surgery methods. While a large incision is made in open surgery, millimetric incisions are sufficient in the robotic method. Blood loss is much higher in open surgery. The pain level is significantly lower in robotic surgery.
The recovery time lasts 6-8 weeks in open surgery, while it drops to 2-4 weeks in the robotic method. The length of hospital stay is longer in open surgery. The risk of complication is meaningfully less in the robotic method. Surgical scars remain much smaller in the robotic method and are cosmetically superior.
Recovery Process and Postoperative Care
The period after discharge is a process where your body renews itself and returns to its former state. After robotic benign hysterectomy surgery, this process passes much shorter and more comfortably compared to traditional methods.
How long is the recovery period?
The total recovery period after robotic hysterectomy surgery is 2-3 weeks. This period is quite short compared to the 6-8 week recovery period after open surgery. While recovery takes 4-6 weeks in the laparoscopic method, robotic surgery provides a distinct advantage in this regard. Your hospital stay is usually one night, but in some cases, you can be discharged on the same day. You may experience mild fatigue and loss of appetite for the first few days. Pain in the surgical area is virtually nonexistent.
What to do after surgery
You can take a shower standing up 48 hours after the surgery. Thanks to waterproof dressings, your wound area is protected. Early movement is of critical importance; you are encouraged to walk a few hours after surgery. Light walks increase blood circulation and prevent blood clots. You should consume plenty of fluids; this ensures both the cleansing of your body and the prevention of constipation. Fiber-rich nutrition regulates bowel movements. You should use the painkillers recommended by your doctor regularly. Keeping the wound area clean and dry reduces the risk of infection. If you notice redness, increased warmth, or foul-smelling discharge at the incision site, you should contact your doctor immediately.
What not to do after surgery
You should not lift loads heavier than 5 kilograms for the first 4-6 weeks. Heavy lifting can cause sutures to strain. You should avoid high-tempo exercises, running, and jumping. You should not take a tub bath, nor enter the pool and sea. You should take a break from sexual intercourse for 6-8 weeks. Nothing should be inserted into the vagina. You should stay away from sudden movements.
Return to normal activities
If you work at a desk job, you can return to work within an average of one week. The decision to drive depends on having enough abdominal muscle strength to brake suddenly. You can usually drive after 1-2 weeks. After the second month, you can do light sports that do not strain the abdominal muscles. Your doctor will review your progress and tell you when you can return to your normal activities.
Frequently Asked Questions
Is robotic hysterectomy painful?
Pain after robotic hysterectomy surgery is much less compared to open surgery. The pain you feel usually occurs short-term at the trocar entry sites. This pain can be easily controlled with mild painkillers.
Pain is at its most intense level during the first few days. The average pain process progresses as follows: you may experience moderate pain in the first 3-5 days, pain decreases significantly within 1-2 weeks, and at the end of 4-6 weeks, daily life becomes painless for most patients. Pain is generally less in closed surgeries and is easily controlled with the painkillers given by your doctor. Pain after general anesthesia decreases every hour and usually reaches an acceptable level in 6-7 hours.
Will there be a scar after surgery?
Only keyhole-sized incisions are made after robotic hysterectomy surgery, which leads to a minimal level of scarring. Since the holes opened in closed methods are between 0.5 and 1 centimeter, it is not possible to see any prominent surgical scar when healing is complete.
Very small, millimetric incision scars remain after robotic surgery. These scars lose their prominence over time and are much more cosmetically acceptable than the large incision scars in traditional open surgery. Special care is not required for suture sites, and since absorbable materials are usually used, you do not need to have your stitches removed.
What is the cost of the surgery?
Robotic hysterectomy surgery prices vary depending on many factors. The surgical method, the equipment of the hospital, the scope of the surgery, the patient's additional diseases, the length of hospital stay, and the price of the surgical equipment used are the main factors affecting the price.
Robotic surgeries can be more costly than traditional methods due to the advanced technology used. However, many insurance companies and private health insurances can cover the cost of robotic surgery in certain situations. Uterine surgeries with a medical indication are covered by most private and supplementary health insurance policies under certain conditions. Most private hospitals offer installment options with 6-12 month terms. An examination is mandatory for a net price.
In Summary Robotic Benign Hysterectomy
Uterine removal surgery performed with robotic surgery is one of the most effective treatment options offered by modern medicine. With small incisions, fast recovery, and minimum pain, you can return to your daily life in a much shorter time. Especially if you have benign conditions such as fibroids, endometriosis, or uterine prolapse, this method provides you with significant advantages.
Consult an experienced specialist before making a surgical decision. Determine the most suitable treatment option for your own situation together. With the right approach, robotic hysterectomy surgery offers a reliable path in regaining your health.
Robotic benign hysterectomy is a uterine removal surgery performed with a minimally invasive method. In this article, discover how the surgery is performed and its advantages.
