Gynecology & Robotic Surgery
When medication and noninvasive procedures are unable to relieve symptoms, surgery remains the accepted and most effective treatment for a range of gynecologic conditions. These include but are not limited to cervical and uterine cancer, uterine fibroids, endometriosis uterine prolapse, and menorrhagia (excessive bleeding).
Traditional open gynecologic surgery, using a large incision for access to the uterus and surrounding anatomy, has for many years been the standard approach to many gynecologic procedures. Yet with open surgery can come significant pain, trauma, a long recovery process and threat to the surrounding organs and nerves. For women facing gynecologic surgery, the period of pain, discomfort and extended time away from normal daily activities that usually follows traditional surgery can understandably cause significant anxiety.
Fortunately, less invasive options are available. Some gynecologic procedures enable surgeons to access the target anatomy using a vaginal approach, which may not require an external incision. But for complex hysterectomies and other gynecologic procedures, robot-assisted surgery may be the most effective, least invasive treatment option. Through tiny, 1 cm to 2 cm incisions, surgeons can operate with greater precision and control, minimizing the pain and risk associated with large incisions while increasing the likelihood of a fast recovery and excellent clinical outcomes.
Please see below for information on specific conditions and procedures. For a referral to a skilled robotic surgeon at Suburban Hospital, call 1-855-JHM-3939.
Fibroids & Treatment Options
Uterine fibroids are benign (noncancerous) tumors occurring in at least one quarter of all women. They can grow underneath the uterine lining, inside the uterine wall or outside the uterus. Many women don't feel any symptoms with uterine tumors or fibroids. But for others, these fibroids can cause excessive menstrual bleeding (called menorrhagia), abnormal periods, uterine bleeding, pain, discomfort, frequent urination and infertility.
Treatments include uterine fibroid embolization, which shrinks the tumor, and surgery. Surgical treatment for uterine tumors most often involves the surgeon removing the entire uterus via hysterectomy. While hysterectomy is a proven way to resolve fibroids, it may not be the best surgical treatment for every woman. If, for example, you hope to become pregnant, you may want to consider alternatives to hysterectomy like myomectomy. Myomectomy is a uterine-preserving procedure performed to remove uterine fibroids.
Types of Myomectomy
Each year, roughly 65,000 myomectomies are performed in the United States. The conventional approach to myomectomy is open surgery, through a large abdominal incision. After cutting around and removing each uterine fibroid, the surgeon must carefully repair the uterine wall to minimize potential uterine bleeding, infection and scarring. Proper repair is also critical to reducing the risk of uterine rupture during future pregnancies. Myomectomy can also be performed laparoscopically, but this approach can be challenging for the surgeon and may compromise results compared to open surgery. Laparoscopic myomectomies often take longer than open abdominal myomectomies, and up to 28 percent are converted during surgery to an open abdominal incision.
A new category of minimally invasive myomectomy combines the best of open and laparoscopic surgery. With the assistance of the latest evolution in robotics technology, surgeons may remove uterine fibroids through small incisions with unmatched precision and control.
Physicians perform hysterectomy — the surgical removal of the uterus — to treat a wide variety of uterine conditions. Each year in the United States alone, doctors perform approximately 600,000 hysterectomies, making it the second most common surgical procedure.
There are various types of hysterectomy that are performed depending on the patient's diagnosis:
- Supracervical hysterectomy: removes the uterus and leaves the cervix intact
- Total hysterectomy: removes the uterus and cervix
- Radical hysterectomy or modified radical hysterectomy: a more extensive surgery for gynecologic cancer that includes removing the uterus and cervix and may also remove part of the vagina, fallopian tubes, ovaries and lymph nodes in order to stage the cancer (determine how far it has spread)
Surgeons perform the majority of hysterectomies using an open approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6- to 12-inch incision. When cancer is involved, the conventional treatment has always been open surgery using a large abdominal incision, in order to see and, if necessary, remove related structures like the cervix or the ovaries.
A second approach to hysterectomy — vaginal hysterectomy — involves removal of the uterus through the vagina, without any external incision or subsequent scarring. Surgeons most often use this minimally invasive approach if the patient's condition is benign (noncancerous), when the uterus is normal sized and the condition is limited to the uterus.
In laparoscopic hysterectomy, the uterus is removed either vaginally or through small incisions made in the abdomen. The surgeon can see the target anatomy on a standard two-dimensional (2-D) video monitor, thanks to a miniaturized camera inserted into the abdomen through the small incisions. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy alone.
While minimally invasive vaginal and laparoscopic hysterectomies offer obvious potential advantages to patients over open abdominal hysterectomy, including reduced risk for complications, a shorter hospitalization and faster recovery, there are inherent drawbacks. With vaginal hysterectomy, surgeons are challenged by a small working space and lack of view to the pelvic organs. Additional conditions can make the vaginal approach difficult, including when the patient has:
- A narrow pubic arch (the area between the hip bones where they come together)
- Thick adhesions due to prior pelvic surgery, such as C-section
- Severe endometriosis
- Nonlocalized cancer (cancer outside the uterus) requiring more extensive tissue removal, including lymph nodes
With laparoscopic hysterectomy, surgeons may be limited in their dexterity and by 2-D visualization, potentially reducing the surgeon's precision and control when compared with traditional abdominal surgery.
A new, minimally invasive approach to hysterectomy combines the advantages of conventional open and minimally invasive hysterectomies — but with far fewer drawbacks. Robot-assisted hysterectomy is becoming the treatment of choice for many surgeons worldwide. It enables surgeons to perform surgical procedures with great precision, dexterity and control.
For most patients, robot-assisted hysterectomy can offer numerous potential benefits over traditional approaches to vaginal, laparoscopic or open abdominal hysterectomy, particularly when performing more challenging procedures like radical hysterectomy for gynecologic cancer. Potential benefits include:
- Significantly less pain
- Less blood loss
- Fewer complications
- Less scarring
- A shorter hospital stay
- A faster return to normal daily activities
Moreover, robotic surgery provides the surgeon with a superior tool for dissection and removal of lymph nodes during cancer operations, as compared to traditional open or minimally invasive approaches. Robot-assisted hysterectomy also allows your surgeon better visualization of anatomy, which is especially critical when working around delicate and confined structures like the bladder. This means that surgeons have a distinct advantage when performing a complex, radical hysterectomy involving adhesions from prior pelvic surgery, or nonlocalized cancer or an abdominal hysterectomy.
As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While radical hysterectomy or abdominal hysterectomy performed using robotics are considered safe and effective, these procedures may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.
Other common robot-assisted procedures that are or will be performed at Suburban Hospital:
- Ovarian cystectomies (removal of cyst on an ovary)
- Salpingectomies (removal of fallopian tube)
- Salpingo-oophorectomies (removal of tubes and ovaries)