Dr. Wittenberg recently performed a laparoscopic robotic hysterectomy on a patient with a 24-week size uterine fibroid that weighed over 1200 grams. Dr. Wittenberg kindly took the time to answer questions in regard to this recent surgery below.
What were the patient’s symptoms prior to the hysterectomy?
The patient presented with menorrhagia (heavy menstrual bleeding) and severe anemia (iron deficiency). She also had gradually adjusted to the heavier menses by taking a day or two off from work every month, always having extra super max tampons in addition to maxi pads, carrying extra underwear and black pants in her purse for accidents, and putting extra protective layers on her bed. More recently, she started becoming short of breath when walking up a mild incline hill, and it was this last symptom that brought her to UGSF. When she arrived in the hospital her hemoglobin (blood count) was dangerously low (6). Most women are considered anemic with a count of 10.
How was the patient’s uterine fibroid diagnosed?
She had long been diagnosed with fibroids when she was pregnant and had known they were gradually growing, but was busy with her life.
Why was laparoscopic robotic surgery used as opposed to a standard hysterectomy procedure?
A normal uterus weighs 50 grams, and any time a uterus weighs more than 250 grams advanced laparoscopic surgery techniques are required. This patient’s uterus weighed over 1200 grams, and had grown to 4cm above her umbilicus, so even most advanced laparoscopists would have performed an open surgery with a vertical incision from her belly button or above to her pubic bone. The recovery from an open surgery is extended due to the pain of a large incision. By using with a minimally invasive approach assisted the robotic instruments, she will have a two week recovery rather than a 6-8 week recovery. Her smaller incisions and robotic instruments allow her to recover faster due to less pain and less blood loss than the open procedure. She stayed in the hospital less than a day.
Can you describe a laparoscopic robotic hysterectomy?
There are 2 approaches with robotic assisted laparascopic hysterectomy. If someone has a normal size uterus or only a single incision at the umbilicus is required. If the uterus size or mass is larger, then a few more small incisions are required.
Laparoscopic approach in general means small incisions in the abdominal wall then placing tubes or ports in these incisions that allow instruments to enter the abdomen to do the work. Robotic instruments allow smaller ports and less movement on the abdominal wall and skin than traditional laparoscopic instruments (also called straight sticks or 2D), due to the fact that robotic instruments have 360 degree movement capability (3D) less movement is necessary on the abdominal wall as the fulcrum since most of the movement is inside (therefore not felt by the body).
What can patients expect with this procedure?
Less pain, smaller incisions, and less blood loss — which all translates to faster recovery so you can get back to your life sooner and be happy and healthy.
What is recovery like for a laparoscopic robotic hysterectomy?
In this case, the patient spent less than 23 hours in the hospital following the procedure. Once out of the hospital, patients can expect a recovery period of two weeks, although in her particular case of extreme anemia, she will have to recuperate her red blood cells which naturally can take three months to get to a normal level. Most women without this extreme anemia, can go back to work or school and normal activities in two weeks.
Who is a good candidate for a laparoscopic robotic hysterectomy?
Just about anyone who is a candidate for an open hysterectomy. A larger than 24 week size mass would be hard to get instruments in and see around the uterus, so this would be open.