Robotic Hysterectomy = Laparoscopic Hysterectomy

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.

robotic-hysterectomyClinical 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.