Robotic Help for Hysterectomy Patients [Dr. Larissa Bennis & Dr. Tara Haarsma]

Dr. Bennis: My name is Dr. Larissa Bennis. I am one of the Avera Medical Group OB/GYNs. I deliver babies at the Brookings Health System, and I also do both obstetric and gynecologic procedures here.
 
Dr. Haarsma: My name is Dr. Tara Haarsma. I am an OB/GYN with Avera Medical Group. I deliver babies and do surgical procedures at Brookings Health System.

Why Did You Become a Doctor?
 
Dr. Haarsma: I chose to become an OB/GYN because I really enjoy women's health. I like the variety that comes along with being an OB and a gynecologist. Part of our time is spent in the clinic where we're taking care of patients, helping them with chronic pelvic pain or other issues that females face. I also really enjoy delivering babies. It's always fun to be part of that special process in someone's life. And then we also get the variety of surgical procedures where we can do anything from a hysterectomy to a tubal ligation, or a D&C.
 
Dr. Bennis: I enjoy being involved in women's health care because we get to see patients through the entire lifespan. We get to see patients when they're younger. We get to see patients during the reproductive age years, and then we get to follow those same patients through the later stages of life and into menopause.

What Is a Hysterectomy?

Dr. Haarsma: A hysterectomy is a surgical procedure where we remove the uterus. There are approximately 600,000 hysterectomies performed each year in the United States, and it's quoted that 1 in 3 women by the age of 60 will have had a hysterectomy.

Why Might a Woman Need a Hysterectomy?

Dr. Haarsma: There are several women's health issues that women may need a hysterectomy, and those include uterine fibroids, abnormal uterine bleeding, pelvic pain, endometriosis, uterine prolapse, as well as gynecologic malignancies.

What Are the Different Types of Hysterectomy Procedures?

Dr. Bennis: I would say the, kind of, standard method of doing things is a vaginal approach so there are not any incisions on the abdomen. The uterus, cervix are removed vaginally. There are also options for what would be an open abdominal hysterectomy. That usually involves a fairly large incision on the abdomen and the specimen is removed from the abdomen through that method. And I would say the most recent addition to all of those are the laparoscopic procedures, which can also be, kind of, the standard laparoscopic method, or there are options for robotic types of assistance with those procedures as well.

What is Robotic-Assisted Surgery?
 
Dr. Haarsma: The robotic hysterectomy was introduced in 1999. The advantage over traditional laparoscopy is that the robot has a...the camera has a 10 times magnified view, as well as 3D. So this helps us better visualize the pelvic anatomy and better perform the surgery. The surgical instruments with the robot are wristed, which give us 360-degree rotation. This allows for more flexibility and precision of the surgical procedure.

What Are the Advantages of Robotic-Assisted Surgery?
 
Dr. Bennis: Some of the advantages for robotic procedures are that it can decrease the amount of time that a patient needs to stay in the hospital after the procedure is done. Like Dr. Haarsma was mentioning, the advantage of having some of the 3D imaging and the wristing of the instruments can give us more dexterity doing the actual procedure itself. And especially in patients who have had prior abdominal procedures or have had a history of things like endometriosis that can cause additional adhesions, it gives us a little bit more flexibility to be able to do that procedure without having to do the larger abdominal open procedure.
 
One of the other benefits to robotic procedures is that for patients who are overweight, it can give us an additional method to be able to do that hysterectomy without having to do a large abdominal incision.

How Long Is the Recovery Process?
 
Dr. Haarsma: So with a traditional open abdominal hysterectomy, most women have to stay two nights in the hospital to meet all the criteria for discharge. After a robotic hysterectomy, they typically only stay one night. However, we have had some patients that do go home the same day. The criteria that we're looking for would be able to go to the bathroom on your own, your pain is controlled, be able to ambulate without assistance, and tolerate a regular diet.

What Should Patients Know Before Surgery?
 
Dr. Bennis: So any time we're looking at options for a hysterectomy, we have to take into consideration what the reason is behind all of that. For some patients, there are other options for medication management or less invasive types of procedures. Hysterectomy is considered to be a major surgical procedure, and so we always want patients to be aware of that going into it. We usually talk about the risks and benefits associated with the procedure. I would say, any time we look at doing that, we usually say that there are risks for bleeding, risks for infection, risk for damage to bowel, bladder, or other nearby organs and any time we look at doing a surgical procedure, there is a risk of death. We consider those to be rare risks, but something that we need to make sure a patient is aware of. When we're looking at doing a hysterectomy, we would also want the patient to be aware that there would not be a possibility of them being able to be pregnant after that.
 
The most important thing any time we're looking at doing a surgical procedure is that it is a very individualized patient decision. And so we wanna make sure that the patient is aware of all of their options and that they have discussed those options with their provider.

Would You Recommend Surgery at Brookings Health System?
 
Dr. Bennis: So I would recommend having a hysterectomy here at Brookings Health with the da Vinci robotics equipment because we have a brand-new, state-of-the-art facility. They have done a lot of upgrades here at the hospital within the last few years. We've got a new set of patient recovery areas. We also have a very highly trained surgical team that includes, not only the nursing staff and the OR staff, but also the physicians as well. Both of us have done some additional specialized training to be able to use the robotics equipment, and then here at the hospital, you're gonna be a name, not a number.