Robotic Hysterectomy in Delhi, India

Doctors recommend hysterectomy when uterus-related problems do not respond to other forms of treatment. Some common reasons why a hysterectomy is advised are:

1. A large uterus with multiple fibroids (benign tumours)
2. Cancerous tumours of the cervix or endometrial carcinoma
3. Uterine prolapse (if the uterus has slipped down into the vagina)
4. Endometriosis (cells from the lining of the uterus grow outside it, causing pain and bleeding)
5. Other causes of long-term abnormal uterine bleeding
6. Chronic pelvic pain

Some of the most common indications for robotic hysterectomy include leiomyomata, pelvic relaxation, uterine cancer, excessive bleeding, and endometriosis. Robotic-assisted hysterectomy may be especially helpful in:

1. Patients with obesity
2. Endometrial cancer patients
3. Patients who have complex surgical cases like the advanced stage of endometriosis or pelvic adhesive disease (a scar tissue that binds surrounding organs together)

Robotic hysterectomy is an elective procedure in some cases, excluding those of tumours and post-menopause. Patients suffering from debilitating diseases may opt-out of getting this surgical procedure done.

Before scheduling an appointment for the surgery, inform the surgeons about any underlying medical conditions. A complete body examination and imaging tests assist the operating doctors. Sometime before the day of the surgery, a physical exam is required. The surgeon may also order blood tests, a chest X-ray, or an electrocardiogram (ECG) to check for any other underlying medical conditions. The family history is assessed to prevent anaesthetic complications.

• Smoking can complicate postoperative recovery. It is thus advisable to avoid smoking at least a month before the planned date of surgery.
• If the surgery is carried out under general anaesthesia, one must fast for at least 8 hours before surgery. Discussing with the doctor about taking regular medicines with a sip of water in the morning before the procedure shall be helpful.
• Robotic hysterectomy is a minimally invasive procedure. Light, regular activities can be performed, such as walking, eating, and going upstairs the next day. Once can start driving in about a week or less at the physician's discretion and exercising in about four to six weeks. Doctors review progress and accordingly decide regarding resuming normal activities.

Sometime before the allotted day of robotic surgery, a physical exam is required. The surgeon may also order blood tests, a chest X-ray, or an electrocardiogram (ECG) to check for any other underlying medical conditions.

Wearing loose-fitting clothing and a button-front shirt at the hospital visit for the surgery is helpful. A general meeting with the surgical team is scheduled to discuss the kind of general anaesthetic administered and the patient’s history in depth.

• Robotic hysterectomy is performed under general anaesthesia.
• The laparoscope and surgical instruments are attached to the robotic arms of the computer, and the laparoscopy is inserted into the abdomen. All other instruments are inserted through several other incisions. The surgeon moves to the control area console of the surgical room to remotely control the surgery.
• During a laparoscopic-assisted vaginal hysterectomy, the uterus may be taken out through the vagina. Based on the reason for surgery, only a part of the uterus may be removed or in toto. Sometimes, the attached fallopian tubes and ovaries may also be removed.
• After the surgery, incisions are closed with 1 or 2 sutures and are covered with dressings.

Robotic hysterectomy is a very safe surgical procedure that involves minor complications. Nevertheless, in reality, every surgery carries certain risks and complications. Some of them may include:

1. Heavy, constant bleeding from vaginal vault
2. Formation of clots in the legs or lungs
3. Chances of infection 
4. Damage to the bladder and surrounding tissues/organs
5. Adverse reaction to anaesthesia.

It is imperative to follow the surgeon’s guidelines after the surgery for optimum results. One must go for follow-up appointments for proper evaluation of results. Taking any medicines as directed is vital. Some pain during early recovery is usual. This is what can be expected during recovery at home:

1. Returning to a regular diet gradually helps prevent the ill effects of anaesthesia.
2. The incision areas should be kept dry for a few days. Follow the surgeon's instructions on bathing and dressing care. One may have to re-visit the operating doctor to have the stitches removed.
3. Keep walking to resume normal activities in a few days gradually.
4. Do not do any heavy lifting for a few weeks. Ask the surgeon when can specific activities be returned to.
5. One may continue to have light blood-like discharge from the vagina for several days.
6. The patient is instructed not to put anything into the vagina for at least the first six weeks.
7. Absolute recovery may take anywhere from a few weeks to a few months.

One must inform the surgeon about any of the following incidences during recovery:

1. Increase in pain or pain that is not relieved by medicine
2. Any drainage, bleeding, redness, or swelling from the incision areas
3. Fever
4. Heavy vaginal bleeding
5. Pain or swelling in the legs
6. Chest pain or shortness of breath

Most women recover from a robotic hysterectomy within a short time. The procedure is less painful compared to traditional hysterectomies. Since the incisions are tiny, people can resume their daily activities more quickly. Except for the hysterectomy for cervical cancer, the outcomes of robotic surgery are as successful as open surgery with a shorter recovery period.

Robotic surgery is not advisable for hysterectomies done for cervical cancer except for early cervical cancer, where there is an advantage over the laparotomy approach in terms of blood loss, blood transfusion, complications, and length of hospital stay with the exception of prolonged operating times.

Reviewed by Dr. Ankita Chandna, Associate Director, Obstetrics And Gynaecology on 21-September-2022

1. DO'S AND DON'T'S POST HYSTERECTOMY
2. Da Vinci-The Next Level Technology in Surgical Excellence and Patient Safety
3. Abnormal Uterine Bleeding
4. Scarless and Stitchless Single Incision Laparoscopic Surgery (SILS)- A boon for Female Patients