There are two types of robotic hysterectomy procedures: simple hysterectomy, involving removal of the uterus and cervix, and radical hysterectomy—used as a primary treatment for early-stage cervical cancer—in which the parametria (bands of connective tissue in the pelvis), uterosacral ligaments and upper vagina are also removed. Follow this link to learn more about robotic radical hysterectomy.
Robotic simple hysterectomy is performed to alleviate symptoms associated with benign diseases of the uterus, including fibroids, abnormal bleeding, and adenomyosis, as well as conditions associated with chronic pelvic pain such as endometriosis. In such cases, it's often done together with robotic salpingo-oophorectomy and robotic presacral neurectomy. In addition, robotic simple hysterectomy is utilized as part of larger procedures for the treatment and staging of endometrial cancer and early-stage ovarian cancer. Follow this link to learn more about robotic hysterectomy for malignant conditions.
Robot-assisted surgery is now coming into wider use for these conditions because it allows for excellent visualization of the blood vessels, ureters and surrounding tissue as well as improved ability to suture the vagina after removal of the uterus and cerrvix. Robotic simple hysterectomy also appears to be associated with decreased blood loss during surgery.
In treating benign conditions, five standard quarter-inch incisions are made in the abdomen and ports are placed in the incisions through which the robot's camera and instrument arms are inserted. Next, the surgeon detaches the uterus from its surrounding structures, including the ovaries and fallopian tubes (unless a salpingo-oophorectomy is also being performed, in which case the ovaries and fallopian tubes are removed as well). The surgeon then visualizes clearly the ureters and uterine arteries. The uterine arteries, which are the major suppliers of blood to the uterus, are then cauterized and cut. The cervix may be left in place or removed. If the cervix is to be left in place, the uterus is detached from the cervix and then removed from the abdomen using a special device called a morcellator, which enables the surgeon to cut the uterus into small pieces that can then be taken out through one of the ports. If the cervix is removed as well, additional cuts are made to detach it from the surrounding tissue. The cervix and uterus are then detached together from the vaginal attachment and and removed through the vagina, after which the vagina is sutured shut.
For certain benign conditions, if the patient so desires, it may be possible to perform a robot-assisted supercervical hysterectomy, in which the surgeon removes the uterus but leaves the cervix intact. The American College of Obstetrics and Gynecology advises against this. However, there may be long-term benefit for pelvic organ support. Further study on this topic is needed.
Less blood loss during surgery. Robotic hysterectomy is associated with less intra-operative blood loss compared to open or traditional laparoscopic surgery—reducing the need for blood transfusion.
Superior visualization of the operating site. The magnified 3-D, high-definition image provided by the da Vinci Si surgical system enables excellent visualization of the ureters, blood vessels, and other organs during surgery.
Less scarring. When hysterectomy is performed robotically, the dime-size incisions result in significantly less scarring than with an open procedure.
Less post-operative pain. The smaller incisions used in robotic hysterectomy also result in less post-operative pain than the large abdominal incision employed in open surgery. In addition, there may be less manipulation of the incision sites when using the da Vinci Si surgical system compared to laparoscopic surgery. This may also contribute to decreased post-operative pain—something that is the subject of an ongoing prospective investigation by the gynecologic surgeons at NYU Langone's Robotic Surgery Center.
Faster recovery and shorter hospital stay. Most patients undergoing robotic hysterectomy are able to resume normal activities within 2 to 3 weeks, compared to 6 to 8 weeks for open surgery.
Fewer post-operative complications. Compared to open surgery, minimally-invasive hysterectomy procedures, including robotic hysterectomy, are associated with reduced risk of complications, including infection of the incision sites.
Our surgical program for the management of benign gynecologic conditions is spearheaded by Dr. Kenneth Levey, who specializes in the surgical treatment of fibroid tumors, endometriosis, abnormal uterine bleeding, and chronic pelvic pain. Dr. Levey is one of New York's most experienced surgeons at both robotic and laparoscopic minimally-invasive gynecological procedures, and has used the da Vinci Si surgical robot to perform numerous robotic hysterectomies to relieve chronic pelvic pain related to endometriosis, uterine fibroids, adenymyosis and other conditions, as well as for the treatment of abnormal uterine bleeding.
To watch a video of this procedure being performed by one of NYU Langone Medical
Center's robotic surgeons, click on the link below.