Robotic Hysterectomy (Urologic)

Robotic Surgery for Pelvic Organ Prolapse

Robotic supracervical hysterectomy is performed in order to repair prolapse and/or herniation of the uterus and vagina. When done in conjunction with robotic sacrocolpopexy, it affords a durable and successful repair of pelvic organ prolapse without shortening or scarring the vagina.

Robot-assisted surgery is now coming into wider use for these conditions because it allows a minimally invasive approach to the repair of pelvic organ prolapse with several technical advantages for the surgeon, including enhanced visualization with magnification, reduced blood loss, improved suturing techniques compared to laparoscopy, and reproducible surgical results. And because robotic hysterectomy avoids the need for a large abdominal incision, women undergoing this procedure are able to experience a less painful recovery with a significantly quicker return to normal activities than would be possible with open surgery.

How Robotic Hysterectomy is Performed

A robotic supracervical hysterectomy with preservation of the cervix is performed in cases of advanced uterine prolapse. In this procedure, the patient is placed under general anesthesia and five small incisions are made in the lower abdomen to allow introduction of a camera, three robotic instrument arms and one accessory port for passage of sutures and mesh materials. The uterus is surgically detached and removed, after which the surgeon performs a sacrocolpopexy procedure, in which a small piece of polypropylene mesh is used to anchor the cervix, vagina and bladder to the sacral bone (a large triangular bone located in the upper back of the pelvis). In some cases, the uterus can be preserved and suspended in a similar manner—a procedure known as sacrohysteropexy. Finally, tissues are sewn over the mesh to form a barrier between the mesh and surrounding pelvic organs.

Advantages of Robotic Hysterectomy

Reduced recovery time and hospital time. Since this procedure avoids the need for the large abdominal incision used in open surgery, most patients are able to resume normal activities within 3 to 4 weeks, compared to 6 to 8 weeks for an open hysterectomy.
Less post-operative pain and less need for pain medications.
The superior precision and visualization of operative dissection offered by the da Vinci Si enhances the surgeon's ability to perform hysterectomy with reduced blood loss and more accurate placement of suspension sutures.
The patient is able to maintain natural vaginal length and depth, resulting in reduced vaginal scarring and maintenance of female sexual function.

Robotic Hysterectomy at NYULMC

This procedure has been performed successfully at NYU Langone Medical Center since 2004 in women desiring durable prolapse repair with a minimally invasive approach. Dr. Nirit Rosenblum is one of the few experienced surgeons in the tri-state area to offer robotic surgery for the treatment of pelvic organ prolapse in women, including the option of uterine-sparing surgery (which avoids the need for a hysterectomy). This option of uterine preservation has been especially appealing to many patients, since women are often offered only repairs that include hysterectomy at other surgical centers.

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