Advanced Daycare RAVH (Robotic Assisted Vaginal Hysterectomy) at Fortis Hospital Bangalore

Hysterectomy can be described as the surgical removal of the uterus. Getting a hysterectomy done effectively ends menstruation while also eliminating the possibility to become pregnant. Hysterectomy can be performed for a variety of reasons and may also involve the removal of other organs and tissues, including ovaries and/or fallopian tubes. It can be further divided into partial hysterectomy which means getting the uterus removed or total hysterectomy which involves getting the uterus along with the cervix removed.

Why is hysterectomy performed?

Hysterectomies may be performed to treat conditions such as:

• Uterine fibroids (Leiomyomas) which are causing intense pain & bleeding
• Severe Endometriosis which is characterized by the growth of uterine tissue outside the uterus
• Cancer or pre-cancer of the uterus, cervical or uterine cancer
• Uterine prolapse
• Abnormal vaginal bleeding which is not being controlled by other treatment methods
• Increased intensity of pelvic pain which is not being controlled by other treatment methods

The Surgical Approach

Hysterectomies are routinely performed across the USA to the tune of nearly 600,000 surgeries annually. However, until recently only a tiny minority of the surgeries used to adopt a minimally invasive approach to hysterectomy known as the robotic-assisted vaginal hysterectomy (RAVH). That said, increasingly more and more surgeons across the world have started employing the da Vinci robot-assisted (robotic) for gynecologic surgery.

The magnified, 3-dimensional view allows for incredible precision, flexibility and control. In addition, the articulating arms offer 7-degrees of movement for precise movements enabling the surgeon to make accurate & small abdominal cuts (incisions). The surgeon passes the instruments through these small abdominal incisions. The surgeon can control all these movements from a console that, in turn, provides a greater level of comfort for him/her. Last but not least, this method also drastically decreases the chances of the surgeon experiencing tiredness or fatigue at the end of the day thereby helping reduce the possibility of human error as well.

Patients undergoing a minimally invasive hysterectomy are also likely to experience lower levels of pain, experience decreased blood loss, lesser chances of contracting infections, less scarring as well as quicker recovery time. Patients can recover very quickly from all sorts of difficult/complex surgeries while being able to resume normal daily activities more quickly than one could after undergoing open surgery. All this is possible while also maintaining relatively good outcomes and low complication rates.

A robotic hysterectomy may be recommended if the surgeon is of the opinion that the patient isn’t a good candidate for a vaginal hysterectomy based on the furnished medical history. This might also hold ground if the patient has any existing surgical scars or suffers from some sort of irregularities in his/her pelvic organs thus limiting the patient's options.

The procedure

A robotic-assisted vaginal hysterectomy mandates that the patient gets administered with general anaesthesia to ensure that the patient does not awaken during the procedure. More often than not, the average operating time ranges between 1-3 hours. That said, operative time tends to differ from individual to individual.

The patient is made to lie on the back similar to how one is made to lie down while undergoing a Pap test. In some cases, a urinary catheter might be inserted into the patient to empty his/her bladder. Thereon, approximately 3 to 5 small keyhole (< 1cm) incisions are made in the abdomen and slender surgical instruments are inserted through them. The surgeon remotely controls the robot with the aid of a console located at a short distance away from the patient where the magnified operating field can be viewed in 3-D. With the help of this console, the surgeon will be able to control the surgical instruments in order to remove the uterus.

Depending on the patient’s condition, the surgeon might also proceed to remove one or both ovaries as well as the fallopian tubes