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BACKGROUND: A hysterectomy is a surgical procedure to remove the uterus. According to the United States Department of Health and Human Services, each year, more than 600,000 hysterectomies are performed. Following cesarean section, it ranks as the second most common major operation among women in the United States. By age 60, one in three women in the United States will have had the procedure.

There are various reasons a hysterectomy may be performed. They are mostly done as a result of fibroids, which can sometimes cause heavy bleeding or pain. Other times, the culprit is endometriosis, where the tissue that lines the inside of the uterus grows outside it on the ovaries, fallopian tubes or other organs in the abdominal and pelvic regions. Other reasons for a hysterectomy include uterine prolapse, where the uterus shifts down into the vagina, cancer, persistent vaginal bleeding or chronic pelvic pain.

A NEW OPTION FOR HYSTERECTOMIES: Hysterectomies are typically performed through the abdomen and involve four to eight weeks of recovery. A total abdominal hysterectomy (TAH) requires a four to eight inch incision to take out the uterus and, sometimes, ovaries. A relatively new option exists which reduces recovery time and scars: vaginal, or laparoscopic, hysterectomy. The latter allows most women to return to normal activity in just one or two weeks.

Laparoscopic hysterectomy involves detaching the uterus from within the body using laparoscopic instruments inserted through the abdominal wall, close to the belly button. A laparoscope is a thin, fiber-optic tube with a small video camera attached to the end of it, which allows doctors to see the uterus, fallopian tubes and ovaries. When the cutting of the ovarian attachments are initiated through the abdomen and removed through the vagina, the surgery is referred to as laparoscopic assisted vaginal hysterectomy (LAVH). LAVH combines both vaginal and laparoscopic hysterectomies. The scars from this procedure result from two to four, half-inch incisions.

Another option for women is total laparoscopic hysterectomy, which involves disconnecting the uterus strictly through laparoscopes in the abdomen. When the uterus is successfully detached, it is removed through the vagina or through small half-inch incisions in the abdomen. Experts say this type of procedure is the least painful and most bearable surgery for women who are not eligible for a vaginal hysterectomy, which is sometimes the case with women who have never given birth vaginally, those with long or narrow vaginas, women who have had cancer or women who have very large organs.

LOCAL TECHNOLOGY: Doctors at University and Boone Hospitals use the da Vinci robot to perform the surgery. It is activated by the doctor's touch on hand and foot controls. The result, doctors can use four different instruments at once, "which allows me to control the camera which is a 3D stereoscopic camera and it also allows me to have three working arms" says Dr. Jonathan Thomas of MU Health Care. He adds, laparoscopic hysterectomy means less medication and a shorter hospital stay. "So if we can give a patient a quicker return to their normal life and a less amount of time in the hospital that is a big benefit." 

MORE ON DaVINCI: The da Vinci robot has become the face of modern minimally invasive surgery. It provides surgeons with 3-D visualization, enhanced dexterity, better precision and optimal control during surgery. Traditionally, laparoscopic (or minimally invasive) procedures were only used to treat a limited number of problems because of limitations faced by surgeons. Using the da Vinci robot, more surgeons can perform a wider array of operations laparoscopically using a one to two cm incision. To date, the da Vinci has been used in the operating room for everything from minimally invasive heart surgery to minimally invasive cancer surgery, and also to treat conditions as such as prostate cancer, endometrial cancer, morbid obesity and mitral valve regurgitation.

Some of the benefits of using the da Vinci robot include the following:

· Reduced trauma to the body

· Reduced blood loss and need for transfusions

· Less post-operative pain and discomfort

· Less risk of infection

· Shorter hospital stay

· Faster recovery and return to normal daily activities

· Less scarring and improved cosmetics

HOW IT WORKS: The da Vinci robot consists of an ergonomically designed surgeon's console, a patient-side cart with four interactive robotic arms, a high-performance vision system and proprietary EndoWrist Instruments. State-of-the-art robotic technology powers the system and allows for the surgeon's hand movements to be scaled, filtered and seamlessly translated into precise movements of the EndoWrist Instruments. The System cannot be programmed, nor can it make decisions on its own. The da Vinci System requires that every surgical maneuver be performed with direct input from a surgeon.