Women's Health

A hysterectomy is removal of the uterus (womb). This could be done for a variety of reasons such as symptomatic fibroids, heavy periods, pelvic pain or cancer.

There are different types of hysterectomy:

• Total hysterectomy: removal of uterus (womb) and cervix (neck of womb)
• Subtotal hysterectomy: removal of uterus only

Hysterectomy could be done vial open surgery (abdominal), key hole (robotic / laparoscopic) or vaginally. The way to do the hysterectomy is decided by the indication for surgery.

This means removal of fallopian tube and ovary. This could be done as a sole procedure or part of hysterectomy depending on the reason of surgery.

There are many reasons of heavy periods such as

• Hormonal imbalance (dysfunctional uterine bleeding)
• Fibroids (benign growth within the womb)
• Endometriosis / Adenomyosis
• Cancer such as endometrial cancer (cancer of the womb) but this likely to cause abnormal bleeding outside the period
• Obesity

The treatment will depend on the cause of heavy periods:

• Do nothing could be an option as sometimes periods improve
• Weight loss if overweight
• Non-hormonal medicine such as tranexamic acid
• Hormonal options such as the mini pill, depo injections or Mirena Coil
• Surgery such as excision of endometriosis, endometrial ablation (radiofrequency treatment to lining of the womb) or Hysterectomy.

Minimally invasive surgery is simply surgery performed using smaller incisions. These types of surgeries mean shorter hospitalization and faster recovery for patients. Other benefits may be:

• Less blood loss
• Less scarring
• Reduced risk of infection
• Faster return to your normal life

Until recently in Northumbria all minimally invasive operations were performed laparoscopically (keyhole surgery – where a camera and instruments are inserted through small incisions and controlled manually by the surgeon). These operations are performed commonly by all the surgeons undertaking robotic surgery. Although laparoscopic surgery has all the benefits listed above the surgeon uses 2D television to operate with and the instruments have limited manoeuvrability.

To operate using the robotic system, your surgeon makes tiny incisions in your body and inserts miniaturized instruments and a high-definition three-dimensional camera. Then, from a nearby console, your surgeon manipulates those instruments to perform the operation.

The robot translates your surgeon’s movements in real-time. Your surgeon is in control the whole time; the robotic system responds to the direction he provides.

Many patients are concerned about the idea of a robot performing surgery.  You should know that the Robotic Surgical System is really a system that allows your surgeon to make precise, delicate motions while controlling the machine.  The robot does not make decisions or incisions and never does anything independently or autonomously. Your surgeon controls and directs the robot which allows greater precision than the human hand on its own.

During a robotic-assisted surgery, your surgeon “directs” the surgery from nearby, but does not stand over you like during a traditional surgery. While each surgery is different, here are the general steps to robotic assisted surgery:

1. Your surgeon makes small (one to two centimeter-long) incisions in your body.
2. Your surgeon inserts miniature robotic instruments and a 3D telescope into your body.
3. Your surgeon then sits at a nearby console (a large computer) to direct the procedure. At the console, the area of operation can be seen highly magnified, with excellent resolution.
4. Sitting at the console, your surgeon manipulates the controls, and the robotic instruments respond to these movements, and translate them into precise, real-time movements inside your body.
5. The robotic instruments, which have greater dexterity and range of motion than a human, allow your surgeon to successfully perform delicate surgery in hard-to-reach places.

There are benefits to having a robotic assisted surgery both to you and to the surgical team (these are listed below). However, all operations have risks, both related to having surgery in general, and the specific operation that you are having. The robot does not eliminate or reduce these from happening. Your surgeon will have discussed these risks in detail prior to your operation and sought your consent to proceed with surgery.

• Your surgeon sees a highly-magnified, high-resolution image of the operating field
• Your surgeon has better access to the area being operated on
• Potentially shorter hospital stays
• Less blood loss and fewer blood transfusions
• Potentially less pain
• Faster recovery
• Quicker return to daily routine

Within the Northumbria trust there are 3 teams developing robotic assisted surgery programmes. We are doing this to provide even better-quality treatment to our patients. These are:

• Colorectal Surgery
• Gynaecological surgery
• Upper GI surgery

No. Only some of our surgeons have been selected to take on robotic surgery training. Prior to operating on patients, surgeons must undertake extensive simulation and live robotic training. The initial operations undertaken in a surgeons training are also mentored by an experienced robotic surgeon from another hospital. In addition to this all of the theatre teams and anaesthetic consultants who will be part of the team performing your operation will have been trained about robotic assisted surgery.

Every operation has risks associated with it and your surgeon will discuss these in detail. There can always be additional risks when surgeons learn a new technique that they know will, in time, deliver benefits to patients. We have taken the steps discussed above to make sure all patients are kept safe whilst surgeons are becoming familiar with robotic assisted surgery. Your surgeon will have discussed where they are in their experience using the robot if they are planning to use robotic assisted surgery for your operation.