Care for Women (Moore)



Big Surgery, Little Incisions


Doctor HuebertBy Dr. Allison Huebert

If you are facing big surgery, you may be interested in the option for small incisions. While you might not be concerned about size and location of scars (or maybe you are very concerned!), you are certainly interested in a speedy recovery. Robotic surgery was first approved for use with prostate surgery in men but has gained great use in gynecology. In the past, many more hysterectomies were done through large abdominal incisions. Increasingly, those same surgeries are now being done through tiny incisions with the use of robotic technology. Women facing hysterectomy for fibroids and women with prior abdominal surgery were not considered good candidates for minimally invasive surgery in the past. Advances in medicine now give many more women the option for faster recovery, less blood loss, much less time in the hospital and better cosmetic results.

Women who benefit the most from robotic gynecologic surgery are those who were being offered open abdominal surgery. Those ladies face significant postoperative pain and typically spend 2 nights in the hospital (or more) and weeks on the couch in recovery at home. The robotic approach means one night in the hospital (just a few hours in some cases), minimal postoperative pain and a quick return to your busy life (typically 2 weeks until back at work). Other patients who benefit from robotic gynecology are those with endometriosis or fibroids. In the case of endometriosis, tiny lesions are better seen and treated with the robotic techniques. In patients with fibroids, the improved visualization and instrumentation allows for surgery to be completed with less blood loss because vessels supplying fibroids can be sealed efficiently.

Robotic SurgeryWe often get asked if robotic surgery is safe. The answer is that all surgery has risks, but robotic surgery for gynecology has a great safety track record. The robot only operates at the command of your surgeon. Typically, two surgeons are present with you in the operating room, in addition to anesthesia providers and nursing staff for assistance. Your doctor never leaves your side. The robot offers your surgeon an improved view of pelvic anatomy. Traditional laparoscopy allows only monocular vision (like looking through a telescope) but the robot offers binocular vision (like binoculars). The camera is also controlled by the surgeon so that he or she can direct the camera in the exact area they need to see. Also, unlike traditional laparoscopy, the robotic instruments in the abdomen have fully functioning wrists under the control of your surgeon. These instruments grasp, cut, and even cauterize (seal bleeding points or vessels) under precise control similar to the human hand. So, the robot gives your surgeon excellent eyesight and excellent dexterity through tiny incisions.

Typical incisions for robotic surgery include an 8.5 mm incision at the umbilicus (belly button) and similar sized incisions on the right and left mid abdomen. A fourth incision (same size) higher on the abdomen is used by your doctor's assistant. The uterus (in cases of hysterectomy) is removed from the body through the final incision - the vagina. To perform the hysterectomy, the cervix is detached from its attachment to the vagina at the very top of the vagina. The uterus is removed through the vagina and robotic instruments are used to close that final incision.

Patients who are recovering from robotic surgery note minimal pain, early return to normal bowel and bladder function and quick return to their busy lives. Your Moore Care for Women physicians are all trained in robotic gynecology. We would be happy to discuss your surgical options further with you. While it is true, some patients are not good candidates for robotic hysterectomy, many are. Before you have big surgery, see if you can do it with little incisions. Ask if robotic surgery is right for you.