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Gynecologic Surgery

Hysterectomy is the second most common major surgery performed on women in the United States, behind cesarean section.  By definition, hysterectomy is the removal of the uterus, although it is often performed with removal of cervix, fallopian tubes and sometimes the ovaries.  It is used as a definitive treatment for many benign gynecologic ailments in women’s health, as well as for the treatment of certain cancers.  In 2010, there were approximately 600,000 hysterectomies done in the United States.  It is estimated that one in three women will have had a hysterectomy by the age of 60.

Given the fact that hysterectomy is so common, there have been numerous advances in the last decade to make it a safer and less invasive surgery. There are three different approaches to removal of the uterus, transabdominally, transvaginally and laparoscopically. In 2005, 61% of hysterectomies were performed with an abdominal approach.  This involves making a large incision in the abdomen, usually either a transverse lower abdomen incision, or a vertical lower abdomen incision.  This surgery typically is followed by spending several nights in the hospital for close observation for complications, followed by 6-8 weeks of rest and limited activity.  The vaginal approach to hysterectomy is much less invasive, with lower rates of complications, and less time in the hospital and recovering at home.  Similarly, laparoscopic hysterectomy is a much less invasive surgery than the abdominal approach, with less blood loss, less infection and a much easier recovery for patients.  One goal in women’s health has been to try to shift the primary approach to hysterectomy to a less invasive and safer method.  Although there are advantages to each approach, the fact that the vaginal and laparoscopic approaches result in less blood loss, less infection, less time in the hospital and less time away from work or other routine activities has motivated gynecologists to offer their patients the less-invasive approach whenever possible.

Robotics has been used in surgery for over a decade.  In 2005, the da Vinci surgical system brought the use of robotics to the field of gynecological surgery.  Prior to the introduction of robotics, most cases (61% in 2005) were performed abdominally.  However, today, only 20% of cases are performed abdominally, and robotic assisted laparoscopic hysterectomy has become the most commonly used minimally invasive approach to hysterectomy.  Robotic hysterectomy is simply another way of approaching removal of the uterus laparoscopically.  The benefits of robotics assisted approach over the traditional laparoscopic approach include that the da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist.  Ultimately, robotics allows for more cases to be performed laparoscopically and less cases being converted to the abdominal approach.  The implementation of robotics into gynecological surgery has been a huge advancement in women’s health, and to date, physicians have used the da Vinci System successfully worldwide in approximately 1.5 million various surgical procedures.

Several physicians at North Florida Women’s Care are thoroughly trained in the usage of robotics to perform numerous gynecologic surgeries.  These procedures include hysterectomy, myomectomy, excision of endometriosis, removal of ovarian tumors or cysts, and excision of scar tissue.  If you are contemplating hysterectomy or other gynecologic surgery, please call NFWC and ask to see one of our physicians to discuss a minimally invasive approach to your surgery.

by: Dr. David Dixon

Posted on March 13, 2015

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