Hysterectomy, the removal of only the uterus, remains one of the most frequently
performed surgical procedures in the United States; more than 600,000
operations are completed each year. Most patients undergoing hysterectomy,
(approximately 90%) do so for benign conditions (eg. Fibroids). The surgical
approach used to perform the procedure has evolved significantly and indeed
continues to evolve. Minimally invasive procedures include vaginal and
all types of laparoscopic hysterectomy. Despite these trends, many gynecologists
in the United States persist at performing hysterectomy via a large abdominal
incision (66%), whereas in many other countries minimally invasive hysterectomy
predominates.
Clinical and economic evidence clearly demonstrates that compared with
open abdominal hysterectomy; minimally invasive hysterectomy is associated
with less pain, shorter hospitalizations, fewer complications, and a more
rapid return to normal activities.
While the
robotic assistant has been beneficial in other surgical specialties, it has limited adoption
in benign gynecologic surgery where it enables conversion of an open procedure
to a laparoscopic one. Consequently, the benefits of minimally invasive
surgery are similar. While that is a good development for patient care,
the reality is it takes an additional 45 minutes under anesthesia to set
up the robot, costs the patient thousands of dollars in fees, and ironically
does not eliminate an assistant surgeon. Despite the compelling marketing
hype, there really are no additional benefits.
Perhaps because they have not been given options, patients have been surprisingly
less demanding in requesting minimally invasive hysterectomy and acquiesce
to their gynecologist’s preference, which may be limited to an open
procedure. The gynecologic surgeons at Women’s Health Specialists
were among the first (over 16 years ago) to perform
laparoscopic hysterectomy in the San Francisco Bay Area. Honestly it would be fun to use the robot,
but we can’t with good conscious when we can accomplish a laparoscopic
hysterectomy without one. We need your assistance in educating women,
friends and family, that when conservative measures have failed and a
hysterectomy is indicated they need to persevere to find competent surgeons
who offer a choice of
minimally invasive procedures.