Robotic hysterectomy conjures up a lot of images for my patients. The terms seems to imply that my colleague Dr.Robot will be performing the surgery while I watch. Worse, it conjures up an unwarranted fear that the surgeon might walk out of the room while this is going on. What is the reality?
Robotic Hysterectomy Overview
The reality is that the “robot” is just a tool that the surgeon controls to perform a robotic hysterectomy. Without the surgeon working the delicate instrumentation, the technology that is the “robot” sits idle. Here is an overview of a robotic hysterectomy.
Currently the only system available is the “da Vinci” system, which has been around for multiple generations of robots at this point. While the technology keeps rapidly improving, the kinks for any safety concerns have been ironed out. At this time it is the safest minimally invasive approach available because of several factors. The main two factors are magnified 3-D camera visualization for the surgeon and the ability to move the instruments within as if they were little hands with wrists. Compared with straight laparoscopy instruments, which is reminiscent of operating with chop-sticks, it facilitates difficult surgeries not otherwise possible without a big incision. Laparoscopy still has its place and debates rage as to what is “better” from a patient benefit and cost benefit perspective. Leaving those arguments alone for the moment, let’s focus on how this “robot” works to help you recover quickly from a robotic hysterectomy.
After you are asleep under general anesthesia, the robotic arms are carefully maneuvered to sit suspended over your body. Then the surgeon and assistant place the sleeves instruments through the skin using standard techniques, usually between 4 and 6 in number. The skin incisions for this are about the size that would admit a pencil, and maybe one or two slightly larger ones that are still less than an inch in width. It looks something like this, depending upon how it is “docked” next to your body : on the side, between the legs (most common for robotic hysterectomy) or over the shoulder and more. After this point, at all times, there is at least one scrub nurse and surgeon assistant at the bedside at all times.
The Robotic Surgeon Console
Meanwhile, the surgeon is able to move to a console, usually located in the corner of the operating room, from which they use their fingers to manipulate the surgical instruments while looking into a 3-D box of sorts. It conjures up images of playing certain arcade video games, even though of course the robotic hysterectomy surgery is serious business. The videos below show how a hysterectomy procedure looks inside (a general video from another surgeon on YouTube) and the other from The Doctors show demonstrates an older system but gives you a very good idea of how the surgeons control the instruments. Everyone’s techniques and instrument choice are a little different, but this is an overview as noted. I personally minimize bi-polar cautery forceps which tends to damage surrounding tissues more, but it is required to reduce bleeding when used in moderation.
A robotic surgery for cancer is more extensive in removing other tissues and biopsies of lymph nodes and things of that nature. But this gives you a starting idea of what is going on and why robotic surgery is the recommendation of choice for many conditions, including gynecologic malignancies.