A hysterectomy is surgery to remove a woman’s uterus. It may be done through an incision in the abdomen or through the vagina. Traditional open gynecologic surgery, using a large incision for access to the uterus and surrounding anatomy, has for many years been the standard approach to many gynecologic procedures. Yet open surgery can mean significant pain, trauma, a long recovery process and threat to surrounding organs and nerves.
For complex hysterectomies and other gynecologic procedures, robot-assisted surgery with the daVinci Surgical System may be the most effective, least invasive treatment option. Through tiny incisions, surgeons using the daVinci system can operate with greater precision and control, minimizing the pain and risk associated with large incisions while increasing the likelihood of a fast recovery and excellent outcomes.
Your doctor may recommend any of the following minimally invasive procedures:
- Laparoscopic hysterectomy: A laparoscope is a narrow tube with a tiny camera on the end. Your surgeon will make three to four small incisions in your belly, where the laparoscope and other surgical instruments will be inserted. The uterus is then removed through the small incisions.
- Laparoscopically assisted vaginal hysterectomy: Your surgeon will remove your uterus through your vagina. Your surgeon also will insert a laparoscope and other instruments into your belly through two or three small incisions.
- daVinci robotic surgery is like laparoscopic surgery, but a special machine is used. It is most often used when a patient has cancer or is obese and vaginal surgery is not safe.
Pelvic laparoscopy is a surgical procedure that examines and treats pelvic organs through a laparoscope inserted into the abdomen at the navel. While you are deep asleep and pain-free under general anesthesia, your doctor makes a half-inch surgical cut in the skin below the navel. Carbon dioxide gas is pumped into the abdomen to help the doctor see the organs more easily.
Pelvic laparoscopy is used both for diagnosis and treatment. It may be recommended for:
- Diagnosing a woman who may have appendicitis or salpingitis
- Evaluating infertility
- Looking at and removing an abnormal pelvic mass found on abdominal ultrasound
- Pelvic pain due to:
- Infections (pelvic inflammatory disease) that don't respond to drug therapy
- Uterine tissue found outside the uterus in the abdomen (endometriosis)
- Ovarian cyst
- Scar tissue (adhesions) in pelvis
- Suspected twisting (torsion) of an ovary
- Puncture (perforation) of the uterus
- Removing the uterus (hysterectomy)
- Removing uterine fibroids (myomectomy)
- Sterilization (tubal ligation)
- Surgically treating a tubal pregnancy
Pelvic laparoscopy is not recommended for patients with:
- Severe obesity
- Severe adhesions in the pelvis from other surgeries
Pelvic Prolapse Repair
A pelvic organ prolapse is a condition in which pelvic structures like the bladder or rectum bulge or protrude into the vaginal wall. Despite the fact that as many as 14 million women in the United States suffer from pelvic organ prolapse, most women are not familiar with the condition.
Vaginal vault prolapse is more common in women who have had a hysterectomy and occurs when the uppermost part of the vagina – called the apex – descends into the vaginal canal because it does not have the same support that was there when the uterus was present. As a result, the apex pulls the rest of the vagina down into the vaginal canal or even outside the vagina.
The pain and discomfort with prolapse can be considerable, often limiting women’s physical activity. Vaginal vault prolapse can occur alone or along with a cystocele (dropping of the bladder into the vagina); urethrocele (sagging of the urethra into the vagina); rectocele (pushing the rectum into the vaginal wall); or enterocele (bulging of the small intestine into the vaginal wall.
A procedure may be done while you are under general or spinal anesthesia. Under general anesthesia, you will be unconscious and unable to feel pain. With spinal anesthesia, you will be awake, but you will be numb from the waist down and not feel pain.
Usually, an incision is made through the front wall of the vagina. The bladder is moved back to its normal location. The vaginal wall may be folded, or part of it may be cut away. Sutures are made in the tissue between the vagina and bladder. These sutures will hold the walls of the vagina in the correct position. Your doctor may place synthetic material between the bladder and vagina. If needed, sutures attach the walls of the vagina to the tissue on the side of the pelvis.