The Brigham and Women’s Hospital (BWH) is a world leader in using state-of-the-art robotic surgery to improve hysterectomy outcomes. This advanced technology’s potential to expand the scope of minimally invasive (laparoscopic) surgery and shorten patient recovery time is motivating more and more of our patients to consider robotic surgery.
A total hysterectomy, the most common type of hysterectomy, is the surgical removal of the uterus and cervix. This procedure is often done for endometrial cancer treatment. A radical hysterectomy is a more extreme, i.e., radical, procedure in terms of the amount of tissue removed, as it also allows for the excision of the connective tissues around the uterus and cervix, including 2-3 centimeters of the vagina. This procedure is typically performed to treat cervical cancer.
Robotic hysterectomy uses a combination of high-definition 3D magnification, robotic technology and miniature instruments to enhance a gynecologic oncologist’s laparoscopic skills when removing a patient’s uterus and cervix and, in the case of radical hysterectomy, surrounding tissues as well.
Colleen M. Feltmate, MD, Director of Minimally Invasive Surgery in Gynecologic Oncology at Brigham and Women’s Hospital, and Michael G. Muto, MD, gynecologic oncologist, performed the first robotic radical hysterectomy in New England in September of 2006.
Colleen M. Feltmate, MD, Director of Minimally Invasive Surgery in Gynecologic Oncology at Brigham and Women’s Hospital, and Michael G. Muto, MD, gynecologic oncologist, have used the FDA-approved da Vinci® Surgical System to collectively perform more than 150 robotic hysterectomies for cervical and endometrial cancers. The system consists of a surgeon’s console, equipped with a control panel and a hi-definition monitor, and a patient side-cart, outfitted with slender robotic arms and attended by another surgeon and a nurse.
Unlike traditional open hysterectomy for cancer, which requires one large incision and retraction to accommodate human hands, only tiny incisions in the abdomen (see image below) are required for the slender robotic arms and tiny surgical tools used in a robot-assisted hysterectomy. There are four available arms - one equipped with a high definition 3-D magnification camera and three that act as the surgeon’s arms - each holding a different instrument, depending on the particular task. The camera gives the surgeon enhanced detail, true depth of field and a panoramic view, and the robotic hands’ broad range of movement enables greater dexterity. This enhanced visualization, precision and dexterity provide significant advantages when working around important structures such as the bladder, nerves and blood vessels, thereby avoiding potential injury.
These capabilities are further enhanced by the surgical console’s unique ergonomics that help ease surgeon fatigue and mechanics that enable steady movements. The surgeon remotely guides the robotic arms while seated at the console, located a short distance away from the patient. These smooth and effortless movements, along with the wristed capabilities of the robotic arms, are the most significant advantages that robotic surgery has over traditional minimally invasive surgical procedures.
Robotic surgery’s miniaturization, increased range of motion, enhanced vision and mechanical precision offer significant benefits for our hysterectomy patients, including:
Colleen M. Feltmate, MD, and Michael G. Muto, MD, performed the first radical hysterectomy in New England in September of 2006. Since that time, the Gynecologic Oncology department has completed more than 150 robot-assisted hysterectomies for patients with cervical or endometrial cancers, and nearly all radical hysterectomy for cancer procedures at BWH are now done laparoscopically. In addition to hysterectomies, Drs. Feltmate and Muto also use the da Vinci to stage (determine the extent or severity of a cancer) gynecologic cancers when a hysterectomy has already been performed, but lymph node biopsies have not.
If you would like to schedule a consultation with Dr. Feltmate or Dr. Muto, please call the Patient Referral Service - staffed 8am-5:30pm, Monday through Friday - at 1-800-294-9999, or fill out an online request form.
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