Surgical Options

There are three main ways to perform surgery on the belly: traditional approach or open surgery, and minimally invasive approaches such as robotic surgery and laparoscopic surgery. See below for more information on each approach.

Robotic Surgery

If your doctor recommends a hysterectomy to treat your condition, you may be a candidate for robot-assisted surgery using the da Vinci® surgical system. Using state-of-the-art technology, a robotic hysterectomy requires only a few tiny incisions, so you can get back to your life faster. The system enables your doctor to perform a minimally invasive hysterectomy even for complex conditions with enhanced vision, precision, dexterity and control.

Surgical Options photo

Robotic gynecologic surgery offers women many potential benefits over traditional surgery, including:

  • Less pain
  • Fewer complications
  • Decreased blood loss
  • Shorter hospital stays
  • Lower risk of wound infection
  • Quicker recovery and return to normal activities

Robotic surgery combines the advantages of minimally invasive laparoscopic surgery with the ability to perform very complex surgeries that in the past would have required a vertical incision. It is the next generation of minimally invasive surgery, allowing the surgeon to perform complex surgeries through smaller incisions.

Most patients are able to go home the next day and pain is usually minor and can be managed with oral medications on the first post-operative day. Patients are usually off of pain medicines within one week, though some patients who experience very little pain may only need minimal pain medication.

The average patient recovers within two weeks and can return to work sooner if their jobs require little physical activity. Of course, each patient is unique and your surgeon will advise you when it is safe to return to work and your daily activities. Additionally, there are fewer wound infections, very few hernias, and incisions are often much less noticeable than the large vertical incision traditionally done without robotic technology.

How Robotic Surgery Works

Robotic surgery uses the same type of small incisions as laparoscopic surgery through which similar cylinders (called ports) are placed. Robotic arms are then attached to the ports and instruments are placed through the ports into the abdomen. During surgery, the surgeon controls the robot at a console in the same room as the patient. At the console, the surgeon looks through the viewer and places his thumbs and second finger into holders. The surgeon’s hand movements are translated through the robot arms into the abdomen doing just what the surgeon is doing. Instruments used in robotic surgery technology give the surgeon much more control, and were created to mimic the same motion of a human wrist, which cannot be done during laparoscopy. These advances allow the surgeon to perform surgeries that used to require open surgery.

Instead of the 2D view on the screen during laparoscopy, the surgeon has a 3D view just like during open surgery and can see the various contours of the tissues. In some cases, this view is even better than in open surgery.

Even though robotic surgery is a huge improvement over open surgery, it is still major abdominal surgery and there is still a risk for complications. Post-operatively, patients must restrict physical activity to help ensure a successful recovery process. It is very important not to do anything strenuous for two weeks after surgery, no matter how well you feel. Lifting and strenuous exercise should be limited to a total of six weeks to minimize complications. Most patients will stay overnight after surgery to monitor for any possible complications, even though the risk is very small.

After surgery, someone from our office will contact you at home within 2-3 days for a follow-up. Of course, if you have any concerns at all about your recovery, you are strongly encouraged to contact us. Someone is always on call.

Not all surgeries can be done robotically and your doctor will evaluate whether or not you are a candidate for robotic surgery.

Open Surgery

Open surgery is done through an incision through the skin and deeper layers to get into the abdominal cavity to operate on the female organs (uterus, tubes, ovaries). Gynecologic oncologists almost always cut vertically from the pubic bone to the belly button to allow safe surgery on the female organs, intestines and lymph nodes.

Open surgery has several disadvantages. Vertical incisions are more painful than other types of incisions, and there is an increased risk of developing a hernia. Recovery time is much slower and typically takes about six weeks. Open surgery also carries a higher risk of developing a wound infection, which in some cases leads to the patient being re-hospitalized. Finally, some patients are not pleased with the way the incision looks after it heals. It is important to note though, that when there is a very large mass, this approach may be the only one available to the surgeon.

Laparoscopic Surgery

Laparoscopic surgery generally is not a useful approach for gynecologic oncology surgeries; it lacks the precision of robotic surgery. Like robotic surgery, laparoscopic surgery uses several small incisions (less than one inch) at the belly button and other locations on the abdomen. The surgeon then places thin cylinders and a camera through these incisions into the abdominal cavity. The surgeon manipulates instruments from the handles just outside the abdomen while watching on a screen. Compared to open surgery, laparoscopic surgery patients have shorter hospitalizations, less pain, and a lower risk of developing a hernia. However, gynecologic oncologists are often unable to use laparoscopy to perform complex surgical procedures. As a result, most gynecologic surgeries have been done through an open incision because of their complexity, that is, until robotic surgery revolutionized the system.

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