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Robotic-Assisted Hysterectomies Offer Many Benefits – and Better Outcomes – for Women

May 20, 2016

Technological changes and advances have transformed our lives in countless ways. And many women who have had a hysterectomy at San Ramon Regional Medical Center over the past decade know first-hand exactly how new, innovative technologies are changing healthcare and medicine for the better.

Both traditionally and in the recent past, hysterectomies—the second-most common surgery for women—were performed abdominally, with several potential drawbacks. Because the abdominal, or open, hysterectomy requires significant pulling and stretching of sensitive tissue by the surgeon, recovery time is long. Typically, the patient needs three days in the hospital to recover, and then up to six weeks before she can return to work and/or resume everyday activities. Additionally, there may be significant blood loss.

But there’s a better option now for many hysterectomy patients. A recent study published by The International Journal of Gynecology & Obstetrics found that robotic-assisted hysterectomies, when performed by gynecologic surgeons with relevant high-volume experience, provide improved outcomes compared with abdominal, vaginal and laparoscopic hysterectomies.

In 2005, Mark Lollar, MD, a gynecological surgeon, began performing robotic-assisted hysterectomies at San Ramon Medical Center—shortly after the da Vinci Surgical System, a minimally invasive, robotic surgery system used in hospitals, received FDA clearance that year. Dr. Lollar is one of two doctors at San Ramon Regional Medical Center to perform the surgery robotically.

“This technology is a game changer in so many ways,” says Dr. Lollar.

Dianne Turiano agrees. Turiano, who in 2013 at age 46 had some complications with uterine fibroids, is one of Dr. Lollar’s success stories.  Dr. Lollar suggested the robotic surgery for her in order to preserve her ovaries and fallopian tubes, as well as delay the start of menopause. Although she was a bit skeptical of the procedure and the timelines outlined for her, she decided to proceed because of her trust in and relationship with Dr. Lollar.

“I had the surgery at 3:30 on a Thursday afternoon,” says Turiano. “It took about an hour and I was home by 8. I went shopping for Thanksgiving coming up that week on Saturday, and I was back at work on Monday. I couldn’t believe the recovery process and how accelerated it was. Within two weeks I felt totally fine, and I was back at the gym working out within a month.

“I would recommend this procedure to all women,” she adds. “Having a hysterectomy is an emotional and stressful operation. The da Vinci surgery eliminates the physical trauma associated with the procedure.”

Turiano’s recovery was significantly quicker than the mean length of hospital stay of 1.37 days reported in the study for patients who underwent robotic-assisted hysterectomies. The Feb. 5, 2016 study, titled “Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications,” reported longer length of hospital stays for open (3.0 days), vaginal (1.9 days) and laparoscopic (1.7 days) hysterectomy groups at the nine centers studied.

With results like these, it is not surprising that in the past 10 years, the percentage of abdominal hysterectomies nationwide has decreased from 59% to 22%.

“With the robot, the incisions are very small,” says Dr. Lollar. “Combined with a minimal use of narcotics, most patients do not feel drugged or sleepy after the procedure and they are able to go home quicker. We don’t need to use narcotic pain medication post-surgery. My patients usually are back at the gym, or wherever they want to be, as soon as three days after surgery.”

When Dr. Lollar began performing hysterectomies 20 years ago, the procedures were done abdominally, and it was not uncommon for complications such as fevers and infections to occur. Next came laparoscopic surgeries, and although there was improvement in results, there were drawbacks with mobility. That led to robotic-assisted surgery, which was developed to overcome both the limitations of minimally invasive surgery and to enhance a surgeon’s capabilities.

“With robotics,” says Dr. Lollar, “you have a full range of motion and better dexterity. The robot has two cameras giving you a three-dimensional view. You see everything better—so much so that it looks as if you are inside the patient’s body. The view gives you the confidence to do more delicate and precise movements. Utilizing this technology makes my job fun and interesting.”

According to Dr. Lollar, the training for these hysterectomies is arduous for the physician and requires a major time commitment time (only 5% of gynecologic surgeons perform robotic surgery) and the equipment—at approximately $2 million per system—is expensive. But, as Dr. Lollar points out, once the equipment is purchased, it’s an economically sound investment in the long run as hospitals and insurance companies benefit from shorter hospitalizations.

On average, Dr. Lollar now performs about two robotic hysterectomies per week and expects that to increase as awareness about the benefits grows. He also believes that other specialties and procedures will be utilizing similar robotic technology in the near future.

“This technology clearly makes a dramatic difference in people’s lives,” concludes Dr. Lollar. “That’s why we’re in this profession. It’s extremely gratifying.”