Robotic Hysterectomy Brings Quick Recovery

SmartCare: da Vinci® system offers smaller incisions, shorter hospital stay

Amy Stahle

Amy Stahle of Bettendorf is among
patients who have enjoyed a quicker
recovery with the da Vinci Surgery
System at Genesis, Davenport. She
was able to walk her dog, Millie, two
days after surgery.

When Amy Stahle of Bettendorf heard she needed a hysterectomy, she thought back to her mother's experience 20 years ago.

Coupled with gall bladder surgery at the same time, her mother suffered a lot of pain; had to stay in the hospital for five days; and, endured a lengthy recovery.

Despite having cervical dysplasia in her mid-20s and three C-sections and a gastric bypass under her belt, Amy Stahle always dreaded having a hysterectomy. "I was scared to death," she says. "I thought, ‘I'm going to miss a lot of work; I'm going to be in a lot of pain.' "

In her case, a screening test for cervical cancer had come back suspicious. A subsequent biopsy revealed abnormal cells. Her own grandmother had died of uterine cancer at age 60, and despite her apprehensions, Stahle, 45, knew the time had come for a hysterectomy.

Smart Surgery

Her anxiety eased, however, when obstetrician/ gynecologist Richard Kishiue, M.D., gave her the option of a hysterectomy with the da Vinci® Surgery System at Genesis Medical Center, Davenport. The robotic system offers the most precise, minimally invasive hysterectomy available today.

"This innovative technology gives surgeons improved precision and visibility, with less pain and scarring, a shorter hospital stay and a faster recovery for patients," says Dr. Kishiue of Genesis Health Group, OB/GYN, in Bettendorf.

An OB/GYN since 1985, Dr. Kishiue has seen the evolution from total abdominal and vaginal hysterectomies requiring a three-day hospital stay and a 4-6-week recovery to laparoscopic-assisted vaginal hysterectomies with a 1-2 week recovery. Now, the da Vinci hysterectomy also offers quick recovery.

The da Vinci system is one of the latest technologies of Genesis SmartCare, the array of minimally invasive and noninvasive procedures that get patients back to their normal activity level sooner.

Currently, the majority of hysterectomies are performed through 5-6 inch abdominal incisions, resulting in significant postoperative convalescence, pain, loss of blood and scarring. Stahle received four small incisions during her Oct. 6 surgery and got back to her life faster than the usual weeks required with a traditional hysterectomy.

"I went home from the hospital the next morning and drove to visit my Mom and Dad," she says. "When they saw me, they laughed because they were on their way to visit me at the hospital. This surgery was far easier than I expected."

Two days later, she was walking her dog. She only took four days off work.

Helping Hands

During her procedure, Dr. Kishiue sat at a surgeon's console situated several feet away from his patient on the operating table. Through the console, he could view 3-dimensional images generated by a tiny camera placed inside Stahle's abdomen. With the da Vinci, images are magnified 10 times.

Through several small incisions, he used remote controls to guide electromechanically enhanced surgical instruments. The console is linked to a surgical cart at the patient's bedside, which features four robotic arms that position and maneuver miniaturized, wristed instruments and the 3D camera. The system translated Dr. Kishiue's natural hand movements into precise, real-time movements, allowing for greater accuracy.

Although the term "robotic surgery" is used to refer to the da Vinci System, it can give the false impression that a robot performs the surgery. Instead, the system replicates the movement of the surgeon's hands with the tips of micro-instruments. At no time does the surgeon operate in virtual reality.

"Some patients have the misperception that a robot is doing all the work," Dr. Kishiue says. "I explain that I am working the instruments. I'm close to the bedside, a few feet away at the surgical console, while a bedside surgical assistant helps hold, retract and pass things through."

Overcoming Limitations

The da Vinci also overcomes the limitations of laparoscopicassisted vaginal hysterectomies, where the surgeon operates using rigid, hand-operated instruments that are passed through small incisions and views the anatomy through a scope and monitor that shows a two-dimensional image.

Nothing compares, however, to the excellent visualization and dexterity of the da Vinci.

"With the da Vinci, what you see is 3-dimensional and in high-definition," Dr. Kishiue says. "You can get great magnification and much better visualization. You can actually see the individual blood vessels that come into the uterus."

Dr. Kishiue adds, "The da Vinci's other advantage is you have the ability to bend instruments or flex them much like your wrist. Traditional laparoscopic instruments are basically straight, and you can't turn them."

The da Vinci system was good for Amy Stahle, who had a lot of pelvic scarring from many surgeries and already had a portion of her cervix removed as a result of cervical dysplasia. "She didn't have much cervix protruding into the vagina, so it would have been hard to do a traditional laparoscopic-assisted vaginal hysterectomy," Dr. Kishiue says. "With the da Vinci, a manipulator goes up inside the uterus that enables the surgeon to hold onto it better and help pull it down."

For Stahle, the experience was better than anticipated. As an added bonus, the procedure also put an end to years of heavy menstrual bleeding, which often disrupted her life and made her iron-deficient. "I've had three C-sections and gastric bypass surgery, and my da Vinci hysterectomy was definitely the easiest," she concludes. "I recently went for my first 4-mile walk since my surgery, and I feel great!"

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