Patrick M. Weix, M.D., Ph.D. Answers Questions On: Robotic Hysterectomy and Minimally Invasive Gynecologic Procedures

I use the da Vinci surgical robot to laparoscopically perform hysterectomies (uterus removal), oophorectomies (ovary removal), myomectomies (fibroid tumor removal), and sacralcolpopexy (for some types of pelvic-organ prolapse), as well as to treat some cases of endometriosis.

We’ve been able to do less-invasive laparoscopic procedures for a long time, but unlike traditional laparoscopy, the da Vinci robot gives us more fine control and actual 3-D visualization. This enables us to do more complicated procedures in a minimally invasive fashion.

The da Vinci robot allows us to remove the uterus (hysterectomy) or ovaries (oophorectomy) by making only one small incision inside the belly button. 

These procedures, typically performed under general anesthesia, have a minimal impact on patients and leave a virtually undetectable scar. For a hysterectomy, the uterus (along with the tubes and ovaries if necessary) is removed vaginally. For an oophorectomy, the ovaries are removed through the belly button.

It’s important for patients to understand that single-site robotic hysterectomy is limited to those patients with a uterus below a certain size and weight.

Not always. As with every patient and procedure, we look at the reason the procedure is necessary, the patient’s overall health, goals, and personal preferences, and the benefits versus the risks. 

Sometimes an open surgery is still the best procedure. For example, in patients whose uteruses are so large that no other approach is possible for a hysterectomy, we have to do an open procedure.

When they’re the best and safest option, we try to perform less-invasive procedures.

Radiofrequency ablation is an advanced technology that’s starting to be used to treat uterine fibroid tumors by shrinking them with a special type of electrical energy.

It’s all done laparoscopically and requires only two small incisions. Using a tiny catheter equipped with a sonography device, we’re able to very accurately place several small wires inside a fibroid tumor. We then heat those wires, which destroys the tumor tissue.

This new technique does not have as immediate an effect as actually removing the fibroid tumors, but some women are seeing very good relief from their symptoms. And because it’s less invasive than traditional fibroid-tumor surgery, patients have a much quicker return to function.

It’s a good option for patients who don’t want a hysterectomy at all or want a very minimal surgery.