laparoscopic vs robotic hysterectomy; forgot to ask about myomectomy

Today, I went to see one of highest rated GYN dcotor in the fibroid field. He can do laparoscopic hysterectomy, not robotic hysterectomy. He also said that the surgeon use robotic to do hysterectomy is not a good surgeon. I did not ask why? Since I have multiple big fibroids, I asked him what's percentage of confidence he can do laparoscopicly; he said 90%. it means that conversion rate is 10%. But, the surgeon I saw last year can do a robotic hysterectomy said she can do 100% robotically.

So, what 's the difference between laparoscopic hysterectomy and robotic hysterectomy? Which doctor should I choose?

BTW, GYN doc I saw today also mentioned that there is recurrence with myomectomy and open surgery. But, I forgot to ask him whether it is a worth to try myomectomy in my case. I felt I forgot to ask important questions again. feel kind of down after....why did I always forget to ask import questions?

Thank you very much!
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I did MRI last october. I have 11 fibroids. large subserosal and submucosal fibroids. the largest one is 12X9.1X11.5 two are over 6cm; all othere are 2-4 cms. My uerus is 25.1x11.3x21.9.

No surgeon can be 100% certain they can do it one way. Things happen, things can be worse than expected. My doctor told me if he could not remove it through my vagina because it had never been stretched (never pregnant), he would cut a 4 inch incision. That is the first thing I checked when I woke up - no incision along my other bikini cuts!

Remember each doctor has their preferred surgeries. It could be your doctor never learned the robotic, could be he/she doesn't want to loose you to someone else, could be a number of reasons.

What is important is that you have confidence in the doctor ability to do the surgery correctly with as little chance of problems as possible. Did you by chance ask the doctor is the fibroids are small enough to fit through the vagina or will they be removed through an abdominal incision? Sounds like you need to research, write down questions and go back with them to the doctor. Make sure to write down the answers, maybe even take someone with you. You might want to get another opinion or two, also.

Why would this Dr down surgeons who use the Davinci? My gynecologist is not only known as one of the best in the U.S on it but the world. He was on the team to help design it. He is an excellent surgeon. He also does laproscopic and leaves the decision to the patient which they prefer he use. I chose Davinci because he is so talented on it and because with the high def cameras used he was better able to see more endo hiding in nooks and crannies therefore able to remove more. I also was loaded with fibroids, I mean a huge amount and they were almost all on the outside with one the size of a large egg hanging off the side and he was still able to remove everything vaginally. My suggestion would be go with the Dr you trust most. If its the one who doesn't do Davinci then thats who you should use. But if you think someone who does use robotics could do better go with them. I just think its wrong for him to say a Dr that uses robotics isn't a good surgeon.

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Originally Posted by myu008 Today, I went to see one of highest rated GYN dcotor in the fibroid field. He can do laparoscopic hysterectomy, not robotic hysterectomy. He also said that the surgeon use robotic to do hysterectomy is not a good surgeon. I did not ask why? Since I have multiple big fibroids, I asked him what's percentage of confidence he can do laparoscopicly; he said 90%. it means that conversion rate is 10%. But, the surgeon I saw last year can do a robotic hysterectomy said she can do 100% robotically. So, what 's the difference between laparoscopic hysterectomy and robotic hysterectomy? Which doctor should I choose? BTW, GYN doc I saw today also mentioned that there is recurrence with myomectomy and open surgery. But, I forgot to ask him whether it is a worth to try myomectomy in my case. I felt I forgot to ask important questions again. feel kind of down after....why did I always forget to ask import questions? Thank you very much! --------------------------------------------------------------------- I did MRI last october. I have 11 fibroids. large subserosal and submucosal fibroids. the largest one is 12X9.1X11.5 two are over 6cm; all othere are 2-4 cms. My uerus is 25.1x11.3x21.9.

First, I want to say that I am so sorry you are going through this. And, second, call the office back if you forget to ask questions, it is a very stressful time, so ask questions later if you need to, but as long as it is before you make a decision. Also, in my opinion, as I have had robotic surgery, I would not opt for robotic surgery. But, having said that, just get ALL the information before surgery. I don't feel I was informed and feel that I was rushed and pressured by the doctor that did my robotic surgery, so, slow down, make your own decisions and stand up for yourself. I truly know you can do this and you will feel better afterwards.

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Originally Posted by myu008 Today, I went to see one of highest rated GYN dcotor in the fibroid field. He can do laparoscopic hysterectomy, not robotic hysterectomy. He also said that the surgeon use robotic to do hysterectomy is not a good surgeon. I did not ask why? Since I have multiple big fibroids, I asked him what's percentage of confidence he can do laparoscopicly; he said 90%. it means that conversion rate is 10%. But, the surgeon I saw last year can do a robotic hysterectomy said she can do 100% robotically. So, what 's the difference between laparoscopic hysterectomy and robotic hysterectomy? Which doctor should I choose? BTW, GYN doc I saw today also mentioned that there is recurrence with myomectomy and open surgery. But, I forgot to ask him whether it is a worth to try myomectomy in my case. I felt I forgot to ask important questions again. feel kind of down after....why did I always forget to ask import questions? Thank you very much! --------------------------------------------------------------------- I did MRI last october. I have 11 fibroids. large subserosal and submucosal fibroids. the largest one is 12X9.1X11.5 two are over 6cm; all othere are 2-4 cms. My uerus is 25.1x11.3x21.9.

You should go with the surgeon who you are more comfortable with. If you still have any doubts, don't hesitate to call the office back with more questions. And if you still have doubts, then get a 3rd opinion.

The difference between a laproscopic surgery and a daVinci/robotic surgery is that the robotic machine is only used for a robotic assisted surgery. With a laproscopic surgery, laproscopic tools are used. Both surgeries are supposed to be minimally invasive and leave only small incisions.

Like fiestyfelix, I'm surprised that one doctor would put down other surgeons who are able to use the daVinci method of surgery. Yes, doing a robotic assisted surgery does take a lot of skill and a highly trained surgeon, but using the daVinci method does NOT make a surgeon a 'bad' surgeon. IMO, what it sounds like the first doctor was saying (reading between the lines), HE is not trained/skilled/ or comfortable using the daVinci/robotic surgical method...which is fine. Obviously he has a specific surgical method that he is highly trained in and is comfortable using.

My total DvH was my second surgery, but my first robotic assisted surgery. I prefer the robotic method 100%. I chose my surgeon b/c he is one of the best in the country with the daVinci machine. He is not only highly trained and skilled in using the daVinci machine, but he is a highly skilled surgeon in general, and I was comfortable knowing that he would make the best judgement call, for my health, during surgery. And I knew that there was a possibility that my DvH might become a TAH if need be. Luckily, there were no surprises for my surgeon, so my DvH went as planned.

With the second doctor who does do the daVinci method, like another woman mentioned, with any surgery there is never a 100%. Despite MRI's or ultrasounds, doctors have to be prepared for anything they might find during surgery or any situation that might change the surgical method. Sometimes DvH/RALH do have to be changed to abdominal surgeries. It's important to go into this knowing that something might have to change about the surgical plan during surgery. If you trust your surgeon then you should trust him/her to make the best decisions for your health and well being.

Also, if you are simply having a myomectomy (removal of fibroids) there is a possibility that fibroids will grow back. I think there is about a 20% chance of recurrence. That percentage increases if you have a family history of fibroids and as time progresses. After a myomectomy, fibroids can grow back after a few years or even after 10 years. Often, a myomectomy is done when a woman is trying to keep or improve her fertility. If the uterus is removed then fibroids will not recur b/c fibroids are uterine growths.

No matter what you choose, make sure you are fully informed and know the details of what your doctor's surgical plan is, and the possible outcomes.

I have seen a lot of pbgyns, and i have heard exactly what you were told, by one of them.
I have had open surgery, laprascopic, robot assisted lap and the last one a regular lap. I wanted robot assisted this past one (due to my past with adhesions) but my ob doesn't do robot assisted. When I met with her (before this last surgery, where half of it failed, the lap part) she said she didn't get into the robot kind due to liability. She is apparently one of the best. I was obviously a bit disappointed but I am a challenging patient, you know with complicated issues.
I am pro robotic because of what a previous ob said it would help with the removal of adhesions he found in his first, manual, lap. He said with the davinci, on the table you are tilted backwards (feet elevated), which would allow my organs to roll back to where he could have a better shot at removing adhesions from organs (like the colon).
On the flip side, my current ob said she didn't do davinci because she had a patient go blind because of it.

The specialist I recently saw, his nurse, said that he is so skilled he usually doesn't need robotic assistance. He is known to be the best gyn (only) in my area.
My take is ideally you find an on gun that does both.

Great advice from these ladies here. I really second that you write down questions, and I think it's important to bring in reputable clippings retarding concerns so so that if the doctor says no when you think it is a yes, you have some ammunition.

Hugs!

Ps- please don't rush your decision and try your best to listen to your body as you ask yourself these important questions.

Thank you so much for your support and sharing. The robotic surgeon I saw last year told me that small incisions and two week recovery; removed uterus and Fallopian tube. That's the first time I heared about robotic surgery. Felt like that she did not like patients' questions and she is not very nice with patients. She only does robotic surgery and performed over 1600 already. I was not ready for it last year and cancelled the surgery. I guess that she is good at robotic surgery since she did over 1600 already

The doctor I saw yesterday received many rewards including top doctor. From online, patients pour all great reviews on him. He even removed over 30 or 50 fibroids including one basketball size during mymomectomy from online patients' reviews.

I guess mymomectomy is not good for me since I am almost 50 with multiple large fibroids. Also, he mentioned it will be open surgery. What could be the reason for my age to keep uterus? for general health? From other posts I posted, I have been on fibroids more than 17 years (since doctors told me not to worry it; until recently, I develop spotting issue and pressure issue)

BTW, From MRI report from her hospital, there is litter water in my right kidney. kidney blockage. But, I took MRI CD to ask another radiologist, he said that my kidney is fine. no blockage.

Whom should I trust? stressed out.

I called his office and waiting for his calling back. ask some questions I forgot to ask:

1) why laparoscopy is better than robotic hysterectomy?
2)Is it worth to try myomectomy?

Thank you so much for your support and help.

Ha, Myu, are you in Northern Cali by chance? Or are just so many doctors cross to have any kind of patient who wants knowledge or a say in their care by asking questions and challenging them?!
Please stand strong against your doc getting upset about the questions. I know you are stressed, but maybe you should seek a 3rd opinion from another obgyn?

I cannot comment on the myo question.
And I really don't know why robot assisted (RA) versus regular lap. As I mentioned before I needed RA in order to safely remove adhesions that stuck my colon to my ovary and to the side of my pelvic wall. That same OB didn't feel confident doing that with the lap (DaTAH was my 3rd lap/surgery). Therefore, I would lean more to the RA. Again though, this must be your decision and you may want to dig into the not so good opinions of both to help you with your decision.

Try to stay as calm as you can, take your time in making the decision. Again, you may want a 3rd opinion.

	Quote:
Originally Posted by myu008 Today, I went to see one of highest rated GYN dcotor in the fibroid field. He can do laparoscopic hysterectomy, not robotic hysterectomy. He also said that the surgeon use robotic to do hysterectomy is not a good surgeon. I did not ask why? Since I have multiple big fibroids, I asked him what's percentage of confidence he can do laparoscopicly; he said 90%. it means that conversion rate is 10%. But, the surgeon I saw last year can do a robotic hysterectomy said she can do 100% robotically. So, what 's the difference between laparoscopic hysterectomy and robotic hysterectomy? Which doctor should I choose? BTW, GYN doc I saw today also mentioned that there is recurrence with myomectomy and open surgery. But, I forgot to ask him whether it is a worth to try myomectomy in my case. I felt I forgot to ask important questions again. feel kind of down after....why did I always forget to ask import questions? Thank you very much! --------------------------------------------------------------------- I did MRI last october. I have 11 fibroids. large subserosal and submucosal fibroids. the largest one is 12X9.1X11.5 two are over 6cm; all othere are 2-4 cms. My uerus is 25.1x11.3x21.9.

Myomectomy removes the fibroids. I had one in 1999. Because my fibroids were so larger, I had to have c-sections to deliver both my daughters. I was ok with that bc that meant I could still have children. However, my doc did warn me that fibroids could return. She was right! I was a high risk pregnancy both times. Now, at age 46 I've decided to do a partial hysterectomy. I'm not sure of how old you are or if you have children, but something to factor into your decision is if you want a "band aid' solution that may cause you to visit this issue again later in life or if you just want this to be over. For me, at age 46 (and my tubes are tied) a band aid solution was not an option.

Good luck!

I got 3 opinions for my hysterectomy and repairs. Two doctors wanted to do it with robotic and the other doctor doesn't do robotic. The main difference is with robotic everything is in 3D and some say you can see things better. If you do robotic, make sure the doctor does only robotic surgeries and that he/she does at least 10 to 15 surgeries a week using this method. One of my doctors couldn't tell me how many surgeries he uses a week with robotics and became annoyed with my questions. To me, that meant I needed a new doctor and one that truly would take the time and answer the questions. Also, one of the robotic doctors stated that some insurance companies are denying using this method because it is more money and more time in surgery. So (if you go robotic) make sure your insurance company will cover the difference or even the use of it.

I personally, am not doing robotic because of the information I found out; and I just don't feel comfortable with it or the surgeons that use the device.