A Less Invasive Surgical Procedure (ROBOTIC ASSISTANCE)

I am over 2 months post op and feeling great. I really made the right decision. Not only was my Doctor excellent but he used a ROBOT called Davinci to perform my procedure. The ROBOT allowed him to view my abdoman very clearly to remove disease and perform the surgery successfully. I was discharged in a day in a half and back to work in 3 weeks. They removed everything including my cervix. I am now on .05 Estrodil since (I am 37) I have no ovaries and I feel like a teenager again without the periods and mood swings. yipee!

The reason I am writing this is because I was injured (almost died)last year during a normal laporoscopy for a removal of a blood filled cyst. My Bowels were perforated in error and they did not discover this until 24 hours later. I became very ill and a surgeon had to perform an emergency laporatomy (large incision in my belly) to clean out my abdoman and repair my small intestine. It was horrible. I was in intensive care for 5 days and in the hosiptal for 12 with 2 toddlers and a frightend husband at home. I have experience both procedures and I can honestly say that a Laporoscopic Vaginal Assisted Hystorectomy (LAVH) with the assistance of the Davinci machine is the way to go. I am not a salesperson but a true believer in minimal invasive surgery. Please consider this as an option.

When I first started my research I came to this site and I did not understand the different procedures that were available.

Traditional Hysterectomy
Hysterectomy can sometimes be performed through the vagina. However, when the uterus is enlarged – for example, from fibroids or cancer – an abdominal hysterectomy is preferable. This requires a 6-12 inch incision. In some cases, doctors also remove the ovaries because they are thought to release hormones contributing to the condition.


(LAVH) HysterectomyA Less Invasive Surgical Procedure
If your doctor recommends hysterectomy, you may be a candidate for a new, less invasive surgical procedurecalled da Vinci Hysterectomy. This procedure uses a state-of-the-art surgical system designed to help your surgeon perform a more precise, minimally invasive procedure. For most women, da Vinci Hysterectomy offers numerous potential benefits over traditional surgical approaches, including:

Shorter hospital stay
Less pain
Faster recovery
Quicker return to normal activities
Less risk of wound infection
Less blood loss
Less scarring

I stongly encourage you to find a Doctor/Hospital that has this latest technology and experience. Do not settle for a country/small town OBGYN as I did on my prior Laporoscopy. Most OBGYN's deliver babies and sometimes do not have enough experience to handle the complexity of a Hysterectomy or be an ADVANCED LAPOROSCOPIST. Check them out first. Do not take there word for it. This is major surgery and please do your home work.

God Bless and Good Luck!


Cynick

The less invasive procedures are great and I'm glad that more and more women may be a candidate for them. However, even the robotic procedures are not perfect...no surgical procedure has that kind of guarantee.

And we have atleast one member who had a this kind of surgery and hasn't enjoyed the same successful results. The key is in the doctor's expertise and experience....and even then, there are risks.

Research your surgeon carefully and make sure that they are top-notch.

Hi cynic!

I'm sorry you went through such an ordeal with one of your previous surgeries. How frightening! Thank goodness you had such a wonderful experience with your hyst.

My hyst was also robotically assisted, though I did keep my cervix and ovaries. Afterward the doc said that I'd set some kind of record for the least amount of blood lost. And I healed much more quickly than most of the other sisters who had either an abdominal hyst or an LAVH.

Unfortunately, the good news stops there. I really think that what (((Kathy))) said bares repeating:

"The key is in the doctor's expertise and experience...and even then, there are risks."

And I would add another factor to that key: scruples!

This is what happened to me: I'd had carcinoma in situ of the cervix (pre-invasive cancer), and had had laser surgery to remove the bad cells. After that--and the doc kept saying that this was just a coincidence--I began bleeding each month for longer and longer. Eventually, it became constant. An ultrasound showed what the doc said was a complex cyst on my ovary. He said that my ovary needed to come out, sooner rather than later. When he looked at my uterus, he said that it was distorted with fibroids, and that it really ought to come out as well. I'd had the fibroids for at least 10 years, and they'd never bothered me before. I kept asking him if a hyst was really necessary and never got a satisfactory answer. My bad! The reason I went ahead with it was the constant bleeding, and the fact that I'd had severe and chronic back pain, which he said *might* be alleviated by removing my uterus.

It had only been a year since I'd had the carcinoma in situ. This doc really pressured me into keeping my cervix so that we could use the DaVinci robot for the surgery. If I'd had an LAVH, which is what I wanted, he wouldn't have been able to use the robot. I brought up the issue of my high risk cervix, and he said "Dysplasia is easy to detect and easy to treat." I had a 3 and 5 year old at the time, and felt guilty choosing a surgery that I knew would take longer to recover from.

As I said before, the surgery went well. Once he went in he discovered that the cyst had ruptured already, and wasn't complex after all. (I never would have had the hyst if I weren't already having the oophorectomy! ) But then the mini periods came. The doc hadn't warned me about this possibility, because "it had never happened to him." After 6 months I was having 12 day mini periods and constant cramping.

I went back to my old doc (who had treated me during my pregnancies, but I'd moved since then). He was shocked (and hopping mad!) that this other doc opted to keep my cervix, given my history. I ended up having my cervix removed, along with a urethral suspension that very easily could have been done during the hyst, *and* a few active implants of endo removed. One of them was sitting right on my cervical stump, which is probably what was causing the pressure and bleeding. My doc said that the blood was pooling over the cervix and under the perineum, causing it to bubble up.

I just wanted to pull out the here....If a doc is really pushing you to have a new type of surgery done (and you're not terminally ill, so there is no advantage to taking chances), it should really give you pause. I found out later that I was this doc's first DaVinci patient. He told me that "they" had done 13 or 14 of them--apparently his role in those were to observe! He'd videotaped my surgery and while I was in recovery it seemed like he couldn't leave fast enough, because he was so excited to show the video to his colleagues.

The surgery that *you* had done was even more cutting edge (pardon the pun!) than mine. I *believe* that they used to use the robot only for partial hysts (when leaving the cervix), and that after that they began trying to remove the entire uterus laparoscopically, with the robot. Don't quote me on that! Anyway, some docs get *very* excited about getting some of these new procedures under their belts, and I think that they can lose sight of the patient's best interest. It happened to me! I ended up having a hyst that I don't think I really needed, then a 2nd surgery to fix the first, and then 12 days later I ended up in the ER with a hemorraghe. And all of this has exacerbated my back pain. Just today I saw a new pain specialist who wants to put a pain pump under my abdomen, with a catheter that will deposit pain meds directly into my spine. 6 inch incision in front, and a 2 and a half incision in the back. I can't blame the DaVinci doc for all of that, but my back pain took a huge turn for the worse after the LSH.

Sorry to go on for so long!

Again, many congrats on your successful surgery! Less invasive is great when you're a candidate. I just really wanted to stress that part of doing your homework should involve finding out how many of these surgeries your doc has done, and obtaining at least one other opinion that this is the right way to go.

I would like to clarify the fact that LAVH (ROBOTIC) surgery is not for everyone, however, I am confident that if you are considering a laporscopic hystorectomy, assistance with the Davinci should be considered due to the fact that an experienced doctor can see better. A laporscope only has limited view and is more likely to cause injury than using the robot. Precision is vital.

My Doctor removed my uterus, ovaries, tubes and cervix as well as adhesions and endometriosis vaginally with the assistance of this machine.

The Davinci robot is still fairly new and most hospitals can not afford this as yet. Most of the major (larger)city hospitals have purchased it and have experienced doctors using it.

I agree that getting the best Doctor and hospital is key to the success of any surgery. I researched my Doctor and he not only specialized in my disease but he was a reputable Gynechological Oncologist surgeon. He had a great deal of experience in this type of surgery. I also checked his medical malpractice records. I researched all options as should anyone who is considering this.

My Doctor is a pioneer in this technology. The hospital was incredible as well. The only complaint that I had was not getting enough pain medication and being release in a day in a half. With 2 -two year olds at home I needed more rest.

Bascially, I did my research. I only wanted to share what I learned.

CYNICK

cynic...

for doing your research! I'm sure that after having a near death experience you learned the importance of finding someone with so much experience and expertise. Especially with those precious babies of yours.

My concern is that not all of us are as diligent as you were in preparing for your hyst. I know I wasn't! Once the words "cancer has to be ruled out" were spoken I think I lost the use of the majority of my brain cells. And, given that this is a very new and sophisticated prodedure, there aren't yet a lot of docs out there as well versed as yours. But, there are a lot who would *like* to be , and they don't always represent themselves as accurately as they should. How wonderful for you that your doc is a pioneer!

So, I'm with you...if you've got a reputable, experienced doctor and you are a candidate for robotically assisted surgery, go for it!

The role of the robot was explained to me a little differently...could you clarify?

I was given to understand that the camera is the laparoscope. You have one surgeon at your bedside, who makes the incisions, and another several feet away from you with the TV screen right in front of him/her, operating the controls of the robot. The doc who did my robotically assisted surgery told me that the main advantage of the robot is that its "hands" have no tremor at all, whereas human hands can never be completely free of *some* trembling. So, the chance of nicking a ureter, bladder, bowel or any other nearby organ is significantly reduced.

Since the doc who controls the robot sits right in front of the screen, I could see an advantage in being able to keep an eye on the screen at all times, rather than having to glance up occasionally.

In your research did you learn that the robot *also* has some sort of camera? And that that's why the view is so much better? I didn't know about this part and would be really interested to hear more about it. Another thing I'm wondering about is if your doc feels that a robotically assisted LAVH is less invasive than a regular LAVH. It seems to me that it requires all the same incisions, both internal and external.

s

Margot

Here is a link to some information about this type of hyst if you are interested: http://www.familyjoy.net/cgi-bin/index.cgi?page=gyno.

Yes. There are 5 inicisions rather than 3. I believe there are more cameras. There is a larger dimensional view that allows for more accuracy. I had (2) doctors as well during my procedure.

The regular laporascope is a great tool but the Doctors can not see that well. After my Last Laporoscopy (the one with the injury) I had a large Cysts 3 weeks following. I suspect they missed it entirely because it was so large after the fact.

I ran into these machines by accident because I am in the Transportation business and assisted in the logistics coordination of the demo units to local hospitals in NY. I questioned the technicians when they came in because I was naturally intrested so I am a little more versed than most. I never imagined that 5 years later I would actually be operated by one. They are very expensive machines and most hospitals can not afford them yet. They are selling like crazy now and you will hear more about them as time goes on.

I am grateful and relieved that my historectomy went so well. My Doctor was wonderful and SMART. I am truly blessed to have been in such good hands.

I hope I have answered your question.

CYNICK

Hi Cynick.

I had the daVinci Robotic Assisted LSH on September 12, 2005. At that time, my ob/gyn was the only one using it in gynecology (it was being used primarily in pediatrics and oncology). I am pleased with the results because my ob/gyn was so experienced as a laparoscopist in addition to being well-trained with using the robot. He had already done several of the robotic surgeries before mine, so I had more confidence in his abilities than I would have had otherwise (my rule is to never be the surgical training tool). In the months since, several more physicians have discovered the benefit of offering this option, but it certainly does not mean that all are experienced enough in this technique to be of great benefit to their patients. In competent, skilled hands, the robotic approach is wonderful choice. However, there are two sides to every coin. Yours and my surgical outcomes were wonderful, but as Kathy said, no surgery is perfect.

There are not more cameras in the daVinci, just a greater field of vision because of the two additional dock ports and the lighted magification. As Smargie mentioned, the camera is still in the laparoscope, but the additional dock ports allow the surgeon more views of his/her subject. In summary, it puts the surgeon "up close and personal" to the task at hand. Pretty cool, huh?

Hello,
Now I'm more confused........Question ....the LSH with this robot that your talking about .....the uterus is removed through the holes in the abdomen? How come some people say you if have to have large fibroids you have to have a LAVH or abdomen hysterectomy? I don't even know if we have such a thing as this DaVinci Robotic...I will have to ask the doctor. All I want is to get out of this mess with the least risks as possible and the least pain.....and recovery.......I know I'm selfish and scared to death...I have 3 fibroids 1 about 6 cm and two at about 3cm........Do I even have a choice?

Oceanmist

I had a full LAVH (Vaginal)

I have never heard of removal through holes in the abdomen.