Single-site robotic surgery for hysterectomy

Single-site robotic surgery for hysterectomy

URBANA — When Tonya Retter of LeRoy learned she would need to undergo a hysterectomy earlier this year, she was prepared for a surgery with multiple incisions.

But she liked the option her doctor offered her better — a new, robotic procedure that requires just one small incision — in her navel.

"I think it's less painful, because there's only the one (incision) site," said Retter, a 40-year-old mother of three. "The scar site is in your bellybutton. It's completely non-noticeable."

Retter was Dr. Michael Smith's second patient to undergo a single-site hysterectomy with robotic surgery, she said.

A Christie Clinic obstetrician/gynecologist, Smith performed the 68th single-site procedure in the U.S., and is part of a group of fewer than 100 physicians trained to do it, he said.

A hysterectomy, which is surgery to remove the uterus, is done for a number of reasons, among them cancer, fibroid tumors, prolapse (slippage) of the uterus and severe cases of endometriosis, a condition that can cause pain and irregular bleeding.

Retter, a former Presence Covenant Medical Center labor and delivery nurse, said she was familiar with robotic hysterectomy that requires more incisions but found the single-incision surgery an "excellent option."

She had the procedure at Covenant and spent one night in the hospital, and within four days was back to doing normal family activities and errands, she said.

At her six-week follow-up, she said, she was pronounced completely healed.

About 600,000 women in the U.S. undergo hysterectomies a year, making it the second-most common major surgery for women of child-bearing age.

Hysterectomies can be done a number of ways, including open abdominal surgery, vaginal surgery, laparoscopy and robotic surgery, Smith said.

Both laparoscopic and robotic hysterectomies require the doctor to create several small cuts to insert instruments.

But in a traditional laparoscopy, the surgeon handles the instruments directly and gets a two-dimensional view of what's going inside the patient, and in robotic surgery the physician sits at a console controlling wrist-like instruments connected to robotic arms over the patient, and gets a three-dimensional view.

In the new single-site procedure, even the tiny camera providing a look inside the patient is inserted into the single opening, Smith says.

Traditional laparoscopy, robotic-assisted surgery and vaginal surgery all offer a shorter recovery time, less pain and a reduced risk of complications compared to abdominal surgery, but Smith is a fan of the robotic approach, he says.

The cost of robotic surgery has made it controversial, though.

A study published in the Journal of the American Medical Association in February found that use of the robotic procedure increased substantially between 2007 and 2010, adding at least $2,000 to the cost of the procedure over the cost of a laparoscopic hysterectomy without adding a clear benefit.

In some communities — those that don't have a robotics program — 60 percent to 80 percent of hysterectomies are done as open surgeries, Smith said. In communities such as Champaign-Urbana, where robotic surgery is available at both Covenant and Carle Foundation Hospital, the abdominal surgery hysterectomy rate falls to less than 25 percent, and in some communities, it's even less than 10 percent, he said.

Smith recalls a time when he did more abdominal hysterectomies, and seeing women who underwent those procedures two weeks later still on narcotic pain medicines and so uncomfortable they'd arrive in a wheelchair. He much prefers offering an option that gets them off pain medicines in five days and allows them to return to work a lot sooner, he says.

Plus, he says, when a woman needs pain medicine a shorter time and can get back to work sooner, that tends to help with the emotional and psychological effects women can feel after a hysterectomy.

Robotic surgery for gynecology was just FDA-approved in 2005, Smith said in an email.

"Making the operation more cost-effective and improving the quality is the key goal of every robotics program right now, including ours," he said. "Robotic surgery is like any other technology, though. Look at the history of the computer or the airplane. Like those things, robotic surgery is here to stay, and is the way of the future, and it's something that the informed are supporting."

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