Faster Recovery After Robotic Hysterectomy
Cattle rancher Martha Stewart from the heart of South Dakota is a tough woman. In summer 2017, she was feeling rather “heavier,” with bloating that resembled a pregnancy. But as farmers and ranchers often do, she worked through the discomfort.
Then, while lying in bed, she felt a large, hard bump on her abdomen. She promptly scheduled an appointment with her primary care physician at Avera Medical Group Pierre. An ultrasound showed an enlarged uterus filled with benign tumors called fibroids.
Knowing Stewart needed her uterus removed soon, her physician referred her to Molly Uhing, MD, Avera Medical Group OB/GYN and specialist in robotic surgery.
In the past, hysterectomies were often performed with a long incision up and down the patient’s abdomen, bringing with it a 20 percent complication rate. However, new techniques and robotic surgery allow surgeons to typically remove the uterus through the vaginal cavity. These patients only experience a less than 1 percent complication rate. In Stewart’s case, her uterus had grown to such a size that robotic surgery had to be modified in order for the procedure to be effective.
Stewart would undergo da Vinci® surgery, a minimally invasive robotic procedure designed for faster recovery. For the hysterectomy, three incisions were made in the abdomen which allowed a tiny camera and precise robotic arms into the abdominal cavity. The camera allows the surgeon to see what’s going on under the surface on a high definition screen. The surgeon moves the arms using a set of controllers from a nearby console.
However, Stewart’s uterus had grown to such a size that Uhing extended one incision to the belly button. The uterus was placed inside a bag and brought to the surface near the belly button. Before being removed through the larger incision, Uhing divided the uterus into smaller pieces in a bag.
Uhing performs the removal inside of a self-contained bag in the remote chance of a previously undiagnosed malignancy, so as not to cause any spread of cellular material throughout the abdomen from the fibroid uterus.
“An enlarged uterus has a mass effect on the patient,” explained Uhing. “The uterus could push on a nerve, causing excess pain, as well as fill the pelvis, cause constipation or frequent urination, or lower back pain.”
Used More Often
For certain patients, robotic procedures can mean less pain, less bleeding, less risk of complication and a shorter recovery. Robotic systems are used for more procedures than ever before, including gynecology, gynecologic oncology, cardiothoracic, colorectal, urology, urogynecology and general surgery.
The trend in surgery is more minimally invasive procedures done on an outpatient basis, overnight or with a short hospital stay. Robotics builds upon laparoscopy as a minimally invasive option. The precise movements of robotic arms and miniaturized surgical instruments – still controlled by the surgeon at a computer console – are more precise and allow for greater dexterity.
Visualization for surgeons is better than real life. Robotics technology allows them to see a lighted view in 3-D at up to 10 times magnification on the computer screen as they control surgical instruments.
Within 24 hours, Stewart was heading home to their ranch near Fort Pierre. Just a day or two later, she was outside caring for her animals.
“I got better fairly quickly,” said Stewart. “I no longer feel heavy or bloated, but most importantly, I no longer have pain.”
Stewart advocates for all people to utilize their local health care resources. “If something isn’t quite right or you’ve been feeling under the weather for a while, go to the doctor and get it checked out.”