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Rapid Recovery: How Robotic
Surgery Benefits Women

Matthew Voth, MD, OB-Gyn
Via Christi Clinic
Hysterectomy

  Most common GYN procedure
  1/3 of women by age 60
  620,000 per year
  73% for benign conditions
Reasons for Hysterectomy

  Irregular bleeding
  Painful periods
  Persistent abnormal pap smears
  Uterine prolapse
  Cancer
Types of Hysterectomy

  Total
  Partial
  Radical
Abdominal          Vaginal




 Laparoscopic         Total
Assisted Vaginal   Laparoscopic
Which one to choose?




              VS.
What are we thinking?

  Safest route
  Shortest recovery
  Experience with procedure
  Long term outcome
  Alternatives
What should YOU be thinking?

  Effectiveness
  Shortest recovery
  Long term outcomes
  Alternatives??
Alternatives

   IUD
   Combined Hormone Therapy
   Lysteda
   Endometrial Ablation
   Uterine Artery Embolization
Abdominal Hysterectomy

  Long considered standard
  Better visualization
  Tactile advantage
  EBL 300-500 cc’s
  3 day hospitalization
  4-6 week recovery
Vaginal Hysterectomy

  No abdominal incisions
  EBL 200-500 cc’s
  1-2 day hospitalization
  2-4 week recovery
  Proper patient selection
Laparascopic Assisted Vaginal

  Faster recovery than abdominal approach
  3-4 small incisions
  EBL 100-300 cc’s
  2-4 week recovery
  Easier to get
   ovaries/adhesions
Total Laparoscopic Hysterectomy

  100% completed from above
  Cervix can be left (controversial)
  Morcellator
  EBL 50-500 cc’s
  1-4 week recovery
In an ideal world.....

   Vaginal hysterectomy
Surgery

  Options to consider
da Vinci Robot
Advantages

  Can tackle ALMOST everything
  Recovery of Laparoscopy, visualization
   better than open procedure
  Maneuverability of instruments
  Fast
What to Expect

  1 hour surgery
  Recover 2 hours, then to room
  Catheter out 4-6 hours post-op
  No restriction on eating
  Home the same day or following morning
What to Expect… continued

  Narcotics the first several days
  50% of patients, pain med free at 7 days
  Back to work in 1-3 weeks
Restrictions

VERY IMPORTANT
   No lifting> 20# for 6 weeks
   No intercourse for 6 weeks
Random Thoughts

  Ovarian preservation
  Hormone replacement therapy
Robotic Surgery
Robotic Surgery




     Questions?

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Women's Connection: Robotic Hysterectomy

  • 1. Rapid Recovery: How Robotic Surgery Benefits Women Matthew Voth, MD, OB-Gyn Via Christi Clinic
  • 2.
  • 3. Hysterectomy  Most common GYN procedure  1/3 of women by age 60  620,000 per year  73% for benign conditions
  • 4. Reasons for Hysterectomy  Irregular bleeding  Painful periods  Persistent abnormal pap smears  Uterine prolapse  Cancer
  • 5. Types of Hysterectomy  Total  Partial  Radical
  • 6. Abdominal Vaginal Laparoscopic Total Assisted Vaginal Laparoscopic
  • 7. Which one to choose? VS.
  • 8. What are we thinking?  Safest route  Shortest recovery  Experience with procedure  Long term outcome  Alternatives
  • 9. What should YOU be thinking?  Effectiveness  Shortest recovery  Long term outcomes  Alternatives??
  • 10. Alternatives  IUD  Combined Hormone Therapy  Lysteda  Endometrial Ablation  Uterine Artery Embolization
  • 11. Abdominal Hysterectomy  Long considered standard  Better visualization  Tactile advantage  EBL 300-500 cc’s  3 day hospitalization  4-6 week recovery
  • 12. Vaginal Hysterectomy  No abdominal incisions  EBL 200-500 cc’s  1-2 day hospitalization  2-4 week recovery  Proper patient selection
  • 13. Laparascopic Assisted Vaginal  Faster recovery than abdominal approach  3-4 small incisions  EBL 100-300 cc’s  2-4 week recovery  Easier to get ovaries/adhesions
  • 14. Total Laparoscopic Hysterectomy  100% completed from above  Cervix can be left (controversial)  Morcellator  EBL 50-500 cc’s  1-4 week recovery
  • 15. In an ideal world.....  Vaginal hysterectomy
  • 16. Surgery  Options to consider
  • 18.
  • 19. Advantages  Can tackle ALMOST everything  Recovery of Laparoscopy, visualization better than open procedure  Maneuverability of instruments  Fast
  • 20. What to Expect  1 hour surgery  Recover 2 hours, then to room  Catheter out 4-6 hours post-op  No restriction on eating  Home the same day or following morning
  • 21. What to Expect… continued  Narcotics the first several days  50% of patients, pain med free at 7 days  Back to work in 1-3 weeks
  • 22. Restrictions VERY IMPORTANT  No lifting> 20# for 6 weeks  No intercourse for 6 weeks
  • 23. Random Thoughts  Ovarian preservation  Hormone replacement therapy
  • 25. Robotic Surgery Questions?