ROBOTIC SURGERY FOR WOMEN
Robotic Clinical Information
Located in Greensboro, NC, Dr. Rivard is an expert in robotic assisted surgery for women using the da Vinci Surgical System. This technology is one of the most advanced and least invasive options used today for treating a number of gynecological conditions including endometriosis, uterine fibroids, uterine prolapse, pelvic pain, ovarian cysts and excessive uterine bleeding.
Dr. Rivard was one of the first gynecologists in NC to perform robotic assisted surgery. She performs hysterectomies, myomectomies, ovarian cystectomies, and treatment for severe endometriosis with the da Vinci Surgical System.
​
With this innovative technology, patients have been able to experience a shorter hospital stay, significantly less pain, less blood loss, fewer complications, less scarring and a faster recovery than associated with open surgery and laparoscopy.
The vast majority of women in NC requiring a hysterectomy are still only offered the traditional approach to their surgery with a large abdominal incision.
By transcending the limitations of open surgery and laparoscopy, Dr. Rivard is able to perform surgery using the da Vinci Surgical System to treat even complex conditions including an enlarged uterus and scarring from endometriosis or prior pelvic surgeries.
Before having gynecologic surgery including hysterectomy, myomectomy, ask Dr. Rivard if you are a candidate for da Vinci robotic surgery.
Robotic-Assisted Surgery with da Vinci Systems
What is a da Vinci surgical system?
Da Vinci surgical systems are comprised of three components: surgeon console, patient-side cart, and vision cart.
Expanding what’s possible
It’s fair to say that no one looks forward to surgery, but it may sometimes provide your best option for care. If you and your doctor feel that surgery is right for you, you can explore the different ways doctors can perform the surgery you need.
Traditional open surgery, where a surgeon operates with handheld instruments through a large cut (incision), may be the first method that comes to mind. However, you could also be a candidate for a less invasive approach requiring just a few small cuts, called minimally invasive surgery. Minimally invasive surgery includes laparoscopic surgery and robotic-assisted surgery.
Enhancing your surgeon’s capabilities
Doctors use many technologies that enhance their capabilities beyond what the human body allows. MRI and CT scanners, for example, enable doctors to “see” inside the body. Similarly, many surgeons perform robotic-assisted surgery using a da Vinci system because it extends the capabilities of their eyes and hands.
How it works
Surgeon console
Your surgeon is with you in the operating room, seated at the da Vinci system console. The console gives your surgeon control of the instruments he or she uses to perform your surgery. The da Vinci vision system delivers 3D high-definition views, giving your surgeon a crystal-clear view of the surgical area that is magnified 10 times to what the human eye sees. Your surgeon uses tiny instruments that move like a human hand but with a far greater range of motion.
The system’s built-in tremor-filtration technology helps your surgeon move each instrument with smooth precision.
Patient cart
The patient-side cart is positioned near the patient on the operating table. It is where the instruments used during the operation move in real time in response to your surgeon’s hand movements at the surgeon console.
Vision cart
The vision cart makes communication between the components of the system possible and provides a screen for the care team to view the operation.
Your surgeon in control
The da Vinci surgical system gives your surgeon an advanced set of instruments to use in performing robotic-assisted minimally invasive surgery. The term “robotic” often misleads people. Robots don’t perform surgery. Your surgeon performs surgery with da Vinci by using instruments that he or she guides via a console.
The da Vinci system translates your surgeon’s hand movements at the console in real time, bending and rotating the instruments while performing the procedure. The tiny wristed instruments move like a human hand, but with a greater range of motion. The da Vinci vision system also delivers highly magnified, 3D high-definition views of the surgical area. The instrument size makes it possible for surgeons to operate through one or a few small incisions.
​
A dedicated care team
As a patient, you are at the center of a network of dedicated professionals working together to help you get back to what matters most.
What to expect with robotic-assisted surgery
Every day, thousands of people have a robotic-assisted procedure with the da Vinci surgical system. If you will soon be one of them, it’s helpful for you to understand what robotic-assisted surgery is and what to expect the day of surgery. Because every patient and surgery is unique, be sure to ask Dr Rivard about your particular surgery.
​
Planning and preparation before surgery
The most important thing you can do before surgery is to talk to your surgeon and follow all instructions from your care team. Here’s a list of additional ideas to help you get ready for surgery day.
-
Follow all care team instructions: Your surgery care team will provide a list of important instructions to follow before and after surgery. If you haven’t received a list, ask for one.
-
Check your insurance coverage: To avoid unexpected medical bills, talk to your health insurance provider about your upcoming surgery. Dr Rivard’s team will assist you withunderstanding what your insurance covers and if you need any preauthorization.
-
Prepare for limitations after surgery: Knowing what you may or may not be able to do aftersurgery (i.e. lifting, walking, driving, etc.) can help you make arrangements for at-home care,transportation, food, childcare, pet care, and other tasks of daily living.
-
Dress for comfort: Wear comfortable clothing and shoes for your surgery appointment.
-
Get ready for check-in: Bring your identification, insurance cards, a copy of your Advance
Directive, if needed, and a form of payment to cover any copayments that may be required by your insurance.
Prepare for your recovery
Dr Rivard’s team will provide you with a post-surgery checklist and instructions, but no two people are alike. Be sure to tell your doctor about your situation—your work and family demands, exercise habits, and activities that are important to you. By being specific, your doctor can let you know what you’ll need to do differently during recovery and when you can expect to get back to normal activities. Here are questions you can ask.
1. Care
What kind of care will I need when I get home? Will I need someone to stay with me full time? Will my care provider need to be able to lift me from a chair or bed?
2. Pain
How long does post-surgery pain typically last? What do I need to know about pain management
medications?
3. Diet
Will I have any food or drink restrictions and for how long? Are there foods you recommend?
4. Activity
What activity restrictions do I need to be aware of, i.e. sitting in a chair, lifting, having sex, climbing stairs?
5. Getting back to normal
How long before I can return to work or resume my usual activities?
6. Exercise
How long before I can start exercising again?
​
​
Conditions and Treatments
A wide variety of benign (non-cancerous) conditions can affect a woman’s reproductive system, which consists of the uterus, the vagina, ovaries and fallopian tubes. Most of these conditions affect the uterus, which is the hollow, muscular organ that holds a baby as it grows inside a woman that is pregnant.
​
Common types of gynecologic conditions including endometriosis (non-cancerous growths of the uterine lining), fibroids (non-cancerous growths in the uterine wall), excessive menstrual bleeding and uterine prolapse (falling or slipping of the uterus) can cause chronic pain and heavy bleeding, as well as other disabling symptoms.
​
ENDOMETRIOSIS AND ADENOMYOSIS
Stages of Endometriosis
The stages of endometriosis are ranked as follows: Minimal (I), Mild (II), Moderate (III), or Severe (IV). Staging depends on certain factors. These include the number, size, and site of the implants (endometrial tissue). The stage also depends on the extent of the adhesions and whether other pelvic organs are involved. The severity of your disease may not match the pain you feel. Even mild endometriosis can cause a lot of pain.​
​
TREATMENT FOR ENDOMETRIOSIS
Endometriosis can be treated with hormone therapy, surgery, or a combination of both. Talk to your health care provider to see which treatment is best for your condition.
-
Hormone Therapy
-
Hysterectomy
​
Hormone Therapy
Hormone therapy regulates or blocks the hormones that control your menstrual cycle. This means it can limit the swelling of your endometrium and extra endometrial tissue (implants). This treatment may be used before, instead of, or after surgery. Following are different types of hormone therapies:
-
GnRH Agonists and FSH and LH Inhibitors stop or lower the production of estrogen and progesterone hormones estrogen and progesterone in your body.
-
Birth control pills contain estrogen and progesterone. Birth control pills help to regulate the levels of Progestins are a form of progesterone. Progestins help keep estrogen levels low progesterone.
-
Orilissa
-
MyFembree
Hysterectomy
A hysterectomy is surgery to remove the uterus, and possibly the ovaries and fallopian tubes. There are several conditions that may prompt your doctor to recommend a hysterectomy. They range from benign (noncancerous) conditions, like endometriosis or fibroids, to cancer conditions, like endometrial or uterine
cancer. While the number of women who receive hysterectomies has declined over the last several decades, approximately 400,000 women in the U.S. still receive hysterectomies each year.
​
Types of Hysterectomy
There are various types of hysterectomy that are performed depending on the patient’s diagnosis. All hysterectomies involve removal of the uterus. What can vary are which additional reproductive organs and other tissues that may be removed.
Types of hysterectomy include:
-
Partial or subtotal hysterectomy: This is also known as a supracervical hysterectomy. This• procedure involves removing the uterus, but leaves the cervix intact. This decision is often based upon patient preference. Some women feel that leaving the cervix intact will preserve sexual function following surgery. 2
-
Total hysterectomy: This procedure involves removing the uterus and the cervix. The vagina remains entirely intact. This is the most common type of hysterectomy performed.
-
Removal of the fallopian tubes and ovaries: These organs may or may not be removed during your hysterectomy procedure. This will depend upon your condition, age, and other factors. Often, the ovaries and fallopian tubes are left intact. 3 Removal of the ovaries is called an oophorectomy. Removal of fallopian tubes and ovaries is called a salpingo-oophorectomy.
Approaches to Hysterectomy
Abdominal Hysterectomy
Surgeons perform the majority of hysterectomies using an “open” approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6-12 inch incision.
Vaginal Hysterectomy
A second approach to hysterectomy, involves removal of the uterus through the vagina, without any external incision or subsequent scarring. Surgeons most often use this minimally invasive approach if the patient’s condition is benign (non-cancerous), when the uterus is normal size and the condition is limited to the uterus.
Laparoscopic Hysterectomy
The uterus is removed either vaginally or through small incisions made in the abdomen. The surgeon can see the target anatomy on a standard 2D video monitor thanks to a miniaturized camera, inserted into the abdomen through the small incision. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy.
​
You may encounter shorthand abbreviations describing different approaches to hysterectomy. Some of these are as follows:
-
Total Laparoscopic Hysterectomy (TLH): The uterus and cervix are removed using laparoscopic instrumentation through 3-5 small incisions made in the abdomen is removed through one of the small incisions using an instrument called a morcellator tact, using laparoscopic instrumentation through 3-5 small incisions made in the abdomen. The uterus
-
Laparoscopic Supracervical Hysterectomy (LSH): The uterus is removed, but the cervix is left in inside the vagina. This is often the surgical approach to treat uterine prolapse.
-
Total Vaginal Hysterectomy (TVH): The uterus and cervix are removed through an incision deep inside the vagina. This is often the surgical approach to treat uterine prolapse.
-
Total Abdominal Hysterectomy (TAH): The uterus and cervix are removed through a large abdominal incision. The incision size can vary from 6-12 inches, depending upon the patient’s condition.
​
While minimally invasive vaginal and laparoscopic hysterectomies offer important potential advantages to patients over open abdominal hysterectomy – including reduced risk for complications, a shorter hospitalization and faster recovery – there are inherent drawbacks. With vaginal hysterectomy, surgeons are challenged by a small working space and lack of view to the pelvic organs. Additional conditions can make the vaginal approach difficult, including when the patient has:
-
A narrow pubic arch (an area between the hip bones where they come together) 2
-
Thick adhesions due to prior pelvic surgery, such as C-section 3
-
Severe endometriosis 4
With laparoscopic hysterectomies, surgeons may be limited in their dexterity, since the instruments are straight and rigid, and by 2D visualization, both of which can potentially reduce the surgeon's precision and control when compared with traditional abdominal surgery.
​
Robotic Assisted Hysterectomy
This procedure is performed using the da Vinci Surgical System, a breakthrough surgical platform which enables gynecologists to operate with unmatched precision, dexterity and control. da Vinci Hysterectomy, combines the advantages of conventional open and minimally invasive hysterectomies – but with potentially fewer drawbacks.
da Vinci Hysterectomy offers numerous potential benefits over traditional approaches, including:
-
Significantly less pain 6
-
Minimal blood loss and need for transfusion 7,8
-
Fewer complications 8,9
-
Shorter hospital stay 8,9
-
Quicker recovery and return to normal activities 5,6
-
Small incisions for minimal scarring
-
Better outcomes and patient satisfaction, in many cases 8
UTERINE FIBROIDS
Uterine fibroids are benign (non-cancerous) tumors occurring in at least one quarter of all women. 1 They can grow underneath the uterine lining, inside the uterine wall, or outside the uterus. Many women don’t feel any symptoms with uterine tumors or fibroids. But for others, these fibroids can cause excessive menstrual bleeding (also called menorrhagia), abnormal periods, uterine bleeding, pain, discomfort, frequent urination, and infertility. 2
Surgical treatment for uterine fibroids most often involves the surgeon removing the entire uterus, via hysterectomy. While hysterectomy is a proven way to resolve fibroids, it may not be the best treatment for every woman.
If you have the desire to preserve your uterus but not necessarily fertility, there are a number of prescription drug treatments that can help to stop continued fibroid growth or even shrink them. If you hope to later become pregnant, you may want to consider alternatives to hysterectomy like myomectomy. Myomectomy is a uterine-preserving procedure performed to remove uterine fibroids.
​
Treatments for Uterine Fibroids:
-
Embolization
-
Myomectomy
-
Hysterectomy​
​
-
1999. Morbidity and Mortality Weekly Report. Surveillance Summaries. July 12, 2002. Vol. 51 / SS-5. Page 1.1. Center for Disease Control. Keshavarz H, Hillis S, Kieke B, Marchbanks P. Hysterectomy Surveillance — United States, 1994 www.cdc.gov/mmwr/PDF/ss/ss5105.pdf Obstet Gynecol. 2004 Oct;104(4):697-700.2.
-
Harmanli OH, Khilnani R, Dandolu V, Chatwani AJ. Narrow pubic arch and increased risk of failure for vaginal hysterectomy vaginal surgery. Arch Gynecol Obstet. 2004 Sep;270(2):104-9. Epub 2003 Jul 10.3.
-
Paparella P, Sizzi O, Rossetti A, De Benedittis F, Paparella R. Vaginal hysterectomy in generally considered contraindications to randomised controlled trials. BMJ. 2005 Jun 25;330(7506):1478. Review.4.
-
Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of
-
http://www.merck.com/mmhe/sec22/ch242/ch242b.html#sec22-ch242-ch242b-83
-
http://www.nccn.org/patients/patient_gls/_english/_pain/2_assessment.asp
-
http://www.merck.com/mmhe/sec22/ch252/ch252f.html?qt=pain%20during%20intercourse&alt=sh
-
Boggess JF. Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm. J Robotic Surg 2007 1:31-3
-
Payne TN, et al. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol. 2008 May-June;15(3):286-91
​
While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.