Transcription:

Maggie McKay (Host): Welcome to Right Beside You a Reid Health Podcast. I'm Maggie McKay. Finding out you need a hysterectomy can be scary to say the least, but there are options. Today, we'll find out about new enhancements in traditional procedures and all about the benefits of robotic assisted hysterectomy.

Joining me today is Dr. Thomas Duncan, a Gynecologist and OB GYN at Reid Health. It's an honor to have you here today, Doctor. Thank you for making the time to explain what robotic assisted hysterectomy is and all the benefits of it.

Thomas Duncan, DO (Guest): Absolutely. Thanks for letting me join you.

Host: Absolutely. First off, why might a woman need a hysterectomy?

Dr. Duncan: Well, unfortunately, there are many reasons why hysterectomies are needed. A lot of the times there can be excessive bleeding issues or pelvic pain issues that can stem from so many different sources. It can result from a fibroid, which is a benign muscle growth inside of the uterus that is heavy and vascular causing all sorts of problems.

There can be endometriosis. There can be endometriosis, which actually forms within the wall of the uterus called adenomyosis. Those are just a few of the more common reasons why a hysterectomy is done, but like I said, there are many, many different reasons why we get to that point.

Host: How is the procedure normally performed?

Dr. Duncan: So when we're using the robot, to assist with us doing a hysterectomy, we get the patient back into the operating room where they are put off to sleep with anesthesia. Once the patient is asleep, then we make four small laparoscopic incisions that are about half an inch in width. Through those incisions, we put a camera in and then we insert our instruments and then everything is attached to the robot itself.

The attachment to the robot doesn't mean that the robot is performing the hysterectomy. It's simply guiding us as we're making our adjustments from a console that is next to the patient. We don't leave the room. The patient is right next to us so that we can manage anything that would need to be taken care of emergently in case the robot was not adequate for the job. As we are guiding the instruments, we are able to go down and remove the attachments to the uterus, whether that is including the ovaries or leaving the ovaries behind. Typically we would take the fallopian tubes out as well as the uterus and then a small circular incision is done around attachments of the cervix to the vagina.

And that opens up the vaginal canal or the birth canal and allows us to bring the uterus, the cervix and any other portions that we are removing down through the vaginal canal. This makes it so that we can avoid doing a large abdominal incision to be able to get out that large piece of tissue.

Once everything is removed, then we put a row stitches across the top part of the vagina and that's called the vaginal cuff. We then double-check and make sure that everything is hemostatic, which means that there's no further blood loss and that everything is dry. We remove the instruments. And then, we place the stitches underneath the skin to close the skin incisions.

The whole procedure itself will typically take about an hour and a half to maybe two and a half hours, sometimes a little bit more complicated and sometimes more difficult surgeries can take longer, but that is a typical expectation.

Host: What will robotic options provide for women versus traditional measures?

Dr. Duncan: So that's a good question. Robotic surgery, by itself it gives us multiple benefits. One of the major benefits is that while we were doing the hysterectomy, we were able to use instruments that are atypical from a regular laparoscopic surgery. That means that the instrument itself is what we call wristed.

So if you think of a regular laparoscopic instrument, it looks like the classic dinosaur squeezer hand that you can pick up at regular toy store where you put your hand in and you squeeze it. And the dinosaur jaws move up and down. A robotic hysterectomy uses an instrument that has those same jaws, but it can also swing the tip of the instrument, side to side.

So that goes to make a difference. For example, if you're trying to tie your shoes, but you can't move your wrists, it's a much more difficult thing. So those wristed movements allow us to get into the nooks and crannies of the pelvis to decrease the amount of trauma to the surrounding tissue.

It decreases the amount of inflammation, postoperatively. It decreases the amount of blood loss that occurs and patients tend to recover much faster. And that leads to the post-operative benefits. Most of the patients who are recovering from a robotic hysterectomy are able to recover and by about a week and a half or so out from surgery, they don't need any additional pain meds.

Again, that's a typical presentation. The decreased pain is one of most important benefits that we get from doing a robotic surgery.

Host: Who would be a candidate for this type of procedure?

Dr. Duncan: Most of the women are actual candidates for a robotic assisted hysterectomy. There are few very specific reasons why we would avoid doing a robotic hysterectomy. Primarily one of the major ones is if the uterus is just too big and there won't be anything that we can do to it, to be able to reduce it to the point where it can fit down through the vaginal canal.

If that's the case, then if we are having to make a large incision, to be able to remove the uterus up through the abdominal wall, we might as well start by making a large incision instead of starting laparoscopically. And so that would be an indication to do a regular abdominal hysterectomy with a big incision, like a C-section.

Host: So when somebody finds out they need a hysterectomy, do they have the choice or in most cases, do you recommend to the patient that they get the robotic assisted hysterectomy?

Dr. Duncan: That is my normal recommendation. Most often I don't even mention the option of doing an abdominal hysterectomy, just because of the significant risk factors that are associated with that sort of a larger incision, unless obviously there are indications for it. The option to do a simple laparoscopic incision with just the simple jaws for the laparoscopic instruments is something that has been pushed to the side, just because of the additional benefits of robotic hysterectomy.

So it's also something that's not typically brought up. There is also the option of doing a vaginal hysterectomy, where there are no abdominal incisions, but the candidates for that type of a surgery are fairly limited due to the narrow access down to the vaginal canal, making it a much more complex surgery.

And it also makes it so that you can't verify that there is no additional bleeding above the top of the vagina once you complete the surgery.

Host: How do you ease the fears of a patient who may be hesitant about the whole robotic assisted hysterectomy procedure?

Dr. Duncan: So that's not an uncommon concern that comes up. Usually the reason why patients have a concern regarding the robot being utilized to perform hysterectomy, it's simply a misunderstanding or a misinterpretation of what the robot is actually being used as. Like I was saying at the beginning, the robot is a simple addition to our instrument set. It is not actually doing any movements by itself. It is considered a robot because of the advanced mechanations that are contained within it, as well as the advanced computer system that helps aid us as we're making the finite movements with our own fingers.

But the surgeon is the one performing the surgery. There is nothing that the robot does all by itself. And so, it is just simply an additional instrument that allows us to perform a complicated surgery in a more simplified manner, so the patients can recover quicker and have decreased pain after their surgery.

So typically I'll just spend some extra time explaining that, so that they can get a better understanding of what to expect with that so that we can clarify and alleviate some of those concerns.

Host: Thank you so much for explaining this and shedding some light on it, because I'm sure a lot of people don't know about robotic assisted hysterectomy. And now that you have explained it, I think it's a lot less scary.

Dr. Duncan: Yeah, I agree. The nice thing is it is a fairly common procedure. And if a patient does have a concern about it, it is something that can easily be talked amongst their friends. And most likely they probably know somebody who's already had a robotic hysterectomy and simply just hasn't brought it up in the past.

They can talk about their own personal experience and any concerns. And that can be something that can be addressed at further visits before the surgery as well.

Host: That's Dr. Thomas Duncan, a Gynecologist and OB GYN at Reid Health. If you're interested in learning about your options or to schedule an appointment today, call Reid OB GYN at (765) 962-9541. And for more information, please visit Reidhealth.org or to get connected with one of our providers. That wraps up this episode of Right Beside You, a Reid Health podcast.

Please remember to rate, review and subscribe to this podcast and all the other Reid Health podcasts. I'm Maggie McKay. Thanks for listening.