Robotic Hysterectomy (Gynecologic) for Malignant Conditions

Robotic Surgery for Endometrial Cancer and Early-Stage Ovarian Cancer

There are two types of robotic hysterectomy procedures: simple hysterectomy, involving removal of the uterus and cervix, and radical hysterectomy—used as a primary treatment for early-stage cervical cancer—in which the parametria (bands of connective tissue in the pelvis), uterosacral ligaments and upper vagina are also removed. Follow this link to learn more about robotic radical hysterectomy.

Robotic simple hysterectomy is utilized as part of larger procedures for the treatment and staging of endometrial cancer and early-stage ovarian cancer. In addition, robotic simple hysterectomy is performed to alleviate symptoms associated with benign diseases of the uterus, including fibroids, abnormal bleeding, and adenomyosis, as well as conditions associated with chronic pelvic pain such as endometriosis. Follow this link to learn more about robotic hysterectomy for benign conditions.

Robot-assisted surgery is now coming into wider use for these conditions because it allows for excellent visualization of the blood vessels, ureters and surrounding tissue as well as improved ability to suture the vagina after removal of the uterus and cervix. Robotic simple hysterectomy also appears to be associated with decreased blood loss during surgery.

How Robotic Hysterectomy is Performed

In a robotic simple hysterectomy, five standard quarter-inch incisions are made and ports inserted for the robot's camera and instrument arms, as well as a fifth port utilized by the assisting surgeon. If fertility preservation is not a consideration, a bilateral salpingo-oophorectomy is performed as the first step in the procedure. In this case, however, the attachment of the ovaries and fallopian tubes to the uterus are not severed, since the entire uterus, cervix and ovaries will be removed en bloc (together). The surgeon then identifies clearly the ureters and uterine arteries, and the uterine arteries are isolated, cauterized and cut. Additional cuts are then made to detach the cervix from the surrounding tissues until the vagina is reached. The cervix and uterus are then detached together from the vaginal attachment and removed through the vagina.  The vagina is then closed by suturing it together.  This step will usually be utilized as one portion of the complete treatment and staging procedure for early-stage ovarian cancer or endometrial cancer. (For the full procedures, see Robotic Surgery for Early-Stage Ovarian Cancer and Robotic Surgery for Endometrial Cancer.)

Advantages of Robotic Hysterectomy

Less blood loss during surgery. Robotic hysterectomy is associated with less intra-operative blood loss compared to open or traditional laparoscopic surgery—reducing the need for blood transfusion.
Superior visualization of the operating site. The magnified 3-D, high-definition image provided by the da Vinci Si surgical system enables excellent visualization of the ureters, blood vessels, and other organs during surgery.
Less scarring. When hysterectomy is performed robotically, the dime-size incisions result in significantly less scarring than with an open procedure.
Less post-operative pain. The smaller incisions used in robotic hysterectomy also result in less post-operative pain than the large abdominal incision employed in open surgery. In addition, there may be less manipulation of the incision sites when using the da Vinci Si surgical system compared to laparoscopic surgery. This may also contribute to decreased post-operative pain—something that is the subject of an ongoing prospective investigation by the gynecologic surgeons at NYU Langone's Robotic Surgery Center.
Faster recovery and shorter hospital stay. Most patients undergoing robotic hysterectomy are able to resume normal activities within 2 to 3 weeks, compared to 6 to 8 weeks for open surgery.
Fewer post-operative complications. Compared to open surgery, minimally-invasive hysterectomy procedures, including robotic hysterectomy, are associated with reduced risk of complications, including infection of the incision sites.

Robotic Hysterectomy at NYULMC

Our gynecologic oncology surgeons, Dr. Bhavana Pothuri and Dr. John Curtin, are two of New York’s top laparoscopic and robotic surgeons, and have spent many years perfecting minimally-invasive surgical techniques for the treatment of gynecologic cancers. During this time, they have performed numerous robot-assisted hysterectomies as part of their surgical treatments for endometrial and early-stage ovarian cancer.

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