Best, Sheila

The use of the da Vinci for routine gynecologic procedures is purely marketing driven–the hospitals need to recoup the money they paid for the machine and physicians see it as a way to woo new patients dazzled by the technology. There is nothing wrong, medically, with doing a hysterectomy with the da Vinci, but it adds unnecessary costs while providing no benefit to the patient. All of the benefits claimed by the manufacturer of the da Vinci robot are true also of vaginal hysterectomy and laparoscopic hysterectomy without the robot. It is true that laparoscopic hysterectomy is technically somewhat challenging, but if your surgeon isn’t technically skilled enough to do this surgery without the robot, then you might want to think twice as to whether he/she is the surgeon you want operating on you. There are plenty of skilled gynecologic surgeons who do laparoscopic hysterectomy without the robot.

Certain conditions do sometimes warrant the utilizing the technical advantages one can gain with the robot. Some of these are: severe endometriosis, tubal reanastamosis, sacrocolpopexy, cancer cases where lymph node dissection may be needed. Otherwise, straight laparoscopic of vaginal hysterectomy will give you the same benefits of the robot, but with a quicker surgery at less cost to the health care system.

Even without the robot, over 90% of the hysterectomies I perform are done vaginally or laparoscopically, without a large abdominal incision, and my patients get the same benefits as the patients above. I do not currently perform robotic-assisted surgery, but I am planning to learn to, as I do perform other technically difficult surgeries where it may have an advantage.

My take away is that you shouldn’t switch doctors just because yours doesn’t do robotic hysterectomies. However, you should look for a doctor who can do your hysterectomy vaginally or laparoscopically. Unless you have cancer or your uterus is larger than a 4-5 month pregnancy, there is no reason you need to have an old-fashioned abdominal hysterectomy.

The one thing I would ask to have done differently: my surgeon glued the four incisions on my abdomen. They all came apart from simple movement and left fairly deep open wounds. The one with the glue that lasted longest revealed itself last week and now is considerably behind the others in healing. I would ask for disolving sutures or other more secure option.

The system is very expensive, so it will be a while before it is widely available, but this is definitely a postive trend.

Cheers,
Sheila

BTW Sheila, thanks for the link to Recovery!!
Karen

Cheers,
Sheila