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Robotic Hysterectomies. Your Common Questions and Concerns Addressed.

Robotic Hysterectomies. Your Common Questions and Concerns Addressed.

A hysterectomy is an operation in which a woman’s uterus is surgically removed. This may be necessary as a form of treating cancer, uterine prolapse, or other dangerous diseases or medical conditions. Commonly, a laparoscopic hysterectomy is performed as a less invasive procedure using a lighted scope inserted through small incisions. Today, thanks to advances in modern medicine, an alternate form of laparoscopic surgery is available that in many cases speeds recovery and limits discomfort even more—and it involves, robotics.

What is a Robotic Hysterectomy

In robotic-assisted laparoscopic hysterectomy, a surgeon controls the surgical operating instruments using a computer located within the operating room. The benefit to computer-assisted operations is in the ability for all movements to be as steady and precise as possible. Robotics eliminate the possibility of human error, a possibility faced by even the most skilled and experienced surgeons. In addition, robotics allow surgeons to maneuver more precisely into tiny spaces, and with a better view of the area being operated on, again helping to improve accuracy and overall procedural success.

Robotic hysterectomies are typically done under general anesthesia. Commonly, three or four small incisions are made near the belly button. Gas is pumped into the belly to inflate the area and give the surgeon a better view of the interior region. The laparoscope is inserted into one of the abdominal incisions, while the surgical instruments are inserted into the others. Using the robotic controls, the surgeon cuts the uterus into pieces small enough to be removed through the abdominal incisions, or the uterus may be removed through the vagina. The entire procedure typically lasts between three and four hours.

When is a Robotic Hysterectomy Recommended?

Your surgeon may recommend a robotic hysterectomy for any of the following reasons:

  • It is a less invasive procedure compared to an open type of hysterectomy, requiring only small incisions.
  • It often produces less pain and results in a shorter hospital stay.
  • It typically results in an easier recovery.
  • There are fewer risks of complications such as excessive bleeding, or issues related to infection.

Are There Any Risks Involved?

As with any type of procedure, there are possible risks associated with a robotic hysterectomy. Talk to your OBGYN to understand the specific risk-factors that may impact you. In general, some of the risks associated with a robotic hysterectomy include:

  • A reaction to the anesthesia. Robotic-assisted laparoscopic surgery usually takes longer than open surgeries. As a result, you are under anesthesia longer, which may increase your risk of complications.
  • Abdominal, or internal organ damage.
  • Blood clots that may form in your legs and travel to your lungs.
  • Infection.
  • Bleeding.

Other Important Factors

Talk to your OBGYN if any of the following additional risk factors may apply to you:

  • You or someone in your family has ever had a negative reaction to general anesthesia
  • You smoke
  • You are taking any other regular medications

For more information about robotic, versus open hysterectomies, talk to your OBGYN. If you are a candidate for a hysterectomy due to a medical condition, your doctor will help you decide the surgical format that will offer the best results in treating your condition. And Chouchani, Sayegh and Bagnarello MD offers robotic assisted hysterectomies featuring the Da Vinci Surgical System. For more information call our office today.


Understanding the Pros and Cons of Receiving an Epidural

EpiduralOne of the most frequently asked questions the doctors at Chouchani, Sayegh and Bagnarello receive from our pregnant patients is if they should or should not get an epidural. While many women are entering the delivery room demanding that they be given an epidural, other women are staunchly opposed to this form of pain management. Each expectant mother should have a thorough understanding of the pros, cons, and risks involved before she makes a determination as to whether or not she will accept an epidural during delivery.

The Procedure

To perform the epidural, an anesthesiologist will insert a needle between two spinal vertebrae in the lower back. A fine catheter is threaded through the needle, and then removed, so that a mixture of a local freezing agent and a pain medication can be administered into the injection site. As a result, the mother will experience numbness below the waist.

The Pros

Epidurals can provide effective pain relief in many cases, especially in the case of a long, or difficult labor. Additional pros of epidurals include:

  • Mitigating exhaustion: When the pain of contractions keeps you awake, an epidural can ease the pain enough to allow for rest or even a nap.
  • Calming anxiety and speeding labor: For women who are exceptionally nervous or anxious during birth, an epidural can ease pain, allowing a woman to become more calm and less tense, ultimately helping to speed delivery.
  • Easier delivery for “sunny-side up” babies: If the cervix is fully dilated, but your baby is facing your belly button instead of your spine, an epidural can relax the muscles of your vagina and perineum, helping the baby to properly reposition for delivery.
  • Controlling high blood pressure: For women who experience a spike in blood pressure during labor, an epidural can help lower blood pressure to safer levels.
  • Enabling consciousness: For women in need of a non-emergency C-section, epidurals can allow you to remain awake through the final stages of birth.

The Cons

Undesired side effects of epidurals tend to increase with larger doses of medication, longer deliveries, or fetal distress. Cons of receiving an epidural may include:

  • Partial relief: In approximately five to 10 percent of cases, an epidural only provides partial relief, which is improved when additional medication is administered, but only in 75 percent of cases.
  • Less effective labor: Numbness may make it more difficult for you to push through contractions, which can prolong labor, resulting in the need for a forceps or vacuum delivery in approximately 38 percent of cases. In other instances, oxytocin is used to speed stalled delivery, a medication that poses its own risks. In other cases of stalled labor, Pitocin must be administered, increasing the chances of a C-section by two or three times for first time mothers.
  • Perineal injury: Tears and other injuries are more common in women who use epidurals because of the increased need for a vacuum or forceps delivery.
  • Respiratory complications: In some cases, the sensation of numbness extends too far up a woman’s body, which can make breathing and swallowing difficult.
  • Difficulty urinating: Lower body numbness often requires the insertion of a catheter to empty your bladder.
  • Limited mobility: Once an epidural is administered, you will be rendered mostly immobile, keeping you from walking the halls or moving around.
  • Spinal headache: Approximately one percent of women who receive an epidural develop an often severe headache during or after labor, which may linger for days or even weeks in rare cases.
  • Postpartum backache: An epidural can result in bruising at the injection site, or ligament strain from prolonged time spent in the labor position. Either of these complications can cause short or long-term postpartum backache. Long-term backaches are almost twice as likely to occur with an epidural than without.
  • Dropping blood pressure: When an epidural causes too much of a drop in blood pressure, it can cause the baby’s heart to slow. Since a slowed heart rate could indicate a sign of stress in the baby, medications may be administered and if ineffective, a C-section may be necessary.
  • Fever: Epidurals significantly increase the likelihood of developing a fever during labor. In case the fever signals infection, you and your baby may be unnecessarily treated with antibiotics. In some cases, your baby may be admitted to the neonatal intensive care unit (NICU) after delivery to rule out complications.
  • Emotional detachment: With a loss of physical sensations, some mothers feel an emotional detachment from the labor process, which can also make it more difficult for nurses to assess the progress of the labor.
  • Residual complications: In rare cases, further complications can include residual numbness, weakness caused by injury to nerves at the injection site, and most severely, brain damage or death.
  • Undesired effects on the newborn: In some cases, epidural complications may cause side effects for the newborn including short-term neurobehavioral complications such as irritability, inconsolability, decreased ability for visual tracking, less efficient initial suckling behavior, and decreased responsiveness.

Of course deciding whether or not to get an epidural should be based on a conversation that you have with your doctor — on a case by case basis. Remember to talk to your doctor about your questions and concerns regarding the epidural procedure before your delivery, and be prepared to know the risks involved before you make your decision during labor.


Ask the OB-GYN – Is a robotic hysterectomy less invasive or painful?

What are some of the reasons women and their doctors may discuss hysterectomy options?

If a woman is suffering from endometriosis, heavy menstrual bleeding, fibroid tumors, pelvic prolapse or cancer, removing her uterus may be the only option for relief or an important part of achieving better health.

What are the four approaches to hysterectomy?

  1. Open hysterectomy. As the name indicates, this is an open surgery, where your uterus is removed through a large incision. The incision has to be large so your surgeon can see your organs and fit his/her hands and instruments inside your body.
  2. Vaginal hysterectomy. Your surgeon will make a cut in your vagina, operates through this incision and closes it with stitches once your uterus is removed.
  3. Laparoscopic Hysterectomy. Your surgeon will make two or three small incisions in your abdomen, then operate using long instruments and a tiny camera. The camera sends images to a monitor that the doctors will use to monitor their activity as they operate. Your uterus can also be removed through a single incision in you belly button.
  4. Robotic hysterectomy. Similar to a laparoscopic hysterectomy, a robotic hysterectomy allows your surgeon to operate through five small abdominal incisions, or one in your navel. The instruments used can bend and rotate far more than the human wrist can. This gives your surgeon improved precision, dexterity and control.

What are the benefits of robotic hysterectomy?

Because there is far less tissue trauma to the abdomen, patients who undergo a robotic hysterectomy may experience:

  • Significantly less pain
  • Less blood loss
  • Fewer complications
  • Less risk of infection
  • Less scarring due to small incisions
  • Shorter hospital stay and shorter recovery time
  • A faster return to normal daily activities

Every year, approximately 600,000 American women have hysterectomies. Should you be one of them? If you are suffering from one of the conditions mentioned above, ask your doctor what treatment alternatives might be available to you, or discuss the advantages and disadvantages of the different surgical methods—including cost and insurance coverage.

If you’re looking for a new OB-GYN practice we are accepting new patients? Make an appointment with Chouchani, Sayegh and Bagnarello today.


Robotic Hysterectomy — What should you expect?

Earlier this month we featured an article about what a Robotic Hysterectomy is and why someone might need this surgery. In this article, we also covered the benefits and risks of this procedure. At Chouchani, Sayegh and Bagnarello we perform the Robotic Hysterectomy with the da Vinci®Surgical System – which means there are very small incisions and a quicker recovery time than traditional hysterectomies.


What is a Robotic Hysterectomy?

Robotic Hysterectomy might sound a little like something out of a science fiction movie, but in reality it’s a cutting edge, minimally invasive procedure, that is at the forefront of gynecology.

Did you know that besides the C-Section, the second most performed surgery on women in this country is the hysterectomy – or the removal of the uterus?

What are the most common reasons why a woman would need a hysterectomy? 

Here are a few of the most common reasons…

  • Benign fibroid tumors
  • Cancerous tumors
  • Uterine prolapse
  • Endometriosis
  • Long-term abnormal uterine bleeding
  • Chronic pelvic pain

Why robotic?

Benefits of the robotic-assisted laparoscopic hysterectomy include:

  • Smaller incisions, and as a result smaller scars.
  • Less pain and a shorter hospital stay after surgery.
  • An easier and possibly shorter recovery at home.

Are there any risks?

As, with any surgery, there are always risks involved.  Your physician will determine if the benefits of the surgery outweigh complications that may arise.  Although this is a relatively safe procedure, some risks include:

  • Reaction to the anesthesia
  • Infection
  • Bleeding
  • Damage to other organs inside the abdomen
  • Blood clots that form in your legs and may travel to your lungs

At Chouchani, Sayegh and Bagnarello we perform the Robotic Hysterectomy with the da Vinci®Surgical System.  Using this cutting edge technology, we are able to dramatically decrease pain and speed up the recovery process. Through tiny, 1-2 cm incisions, our surgeons using the da Vinci System can operate with greater precision and control, minimizing the pain and risk associated with large incisions while increasing the likelihood of a fast recovery and excellent clinical outcomes.

Are you a candidate for this type of surgery?  Find out more about this amazing procedure.  Or call our office at (716) 633-6363 for details.