Watch a robotic hysterectomy at UnityPoint Health – St. Luke’s Hospital

UnityPoint Health – St. Luke’s Hospital in Cedar Rapids Iowa takes you inside our operating rooms for a robotic hysterectomy a Robot assisted hysterectomy is the surgical removal of a woman’s uterus using the da Vinci Surgical robot The surgical robot allows surgeons to operate through tiny openings about the size of a dime and is minimally invasive surgery This surgery allows patients many benefits such as a shorter hospital stay faster recovery and less pain to name a few Doctors Jerry Rozeboom and Owen McCarron from OBGYN Associates in Cedar Rapids are our surgeons for this procedure This is a 46 year old patient who Has significant abnormal bleeding With their menstrual cycles and has a condition We think called adenomyosis which is a form of endometriosis of the uterine wall Leads to nasty menstrual cycles and lots of cramping and After our usual consultation regarding options in the office She is elected to proceed with definitive management So what we’re doing now is we have to establish what’s called a pneumo peritoneum so we put a Small needle into the peritoneal cavity. The reason we elevated abdominal wall is to get the abdominal wall away from the vital organs internally the vessels in the bowel And then we’re going to insulate gas on about three liters of three to four liters of co2 Into the abdominal cavity which will again Create a space so that we can see in a minute. You’ll see what we see and be able to visualize the internal organs So I know this kind of looks a little bit brutal in a way I’m having the belly wall elevated like this, but it is a way of increasing the safety of this part of the procedure So it takes a few minutes to get accomplished Now we’re gonna mark her tummy where as to where I’m going to put the incisions Yeah, I think yeah we’re gonna place one of them the camera port will go just underneath the umbilicus and Then typically about ten centimeters From the umbilicus laterally on each side will place Another couple of ports. Those are we are three robotic arms, and then dr. McCarran who is helping me here is Going to do a fair amount of manipulation Through a port in our left upper quadrant We’re placing a long-acting Local analgesic here called marcaine Helps a little bit with the post-operative discomfort for the next 12 to 24 hours So far we have 3.5 liters in and we’re just about where we need to be That’s about right there at 3.8 liters Now we’ll make a small incision And then we’ll face what’s called our primary troll cause where the camera will go through And it hits that pocket of gas will confirm that Take all that off and now we’ll get our first look internally to place our other instruments This is a high definition Da Vinci robotic cameras three-dimensional when I sit down it’s a three-dimensional camera And that’s one of the things that makes robotics unique Is that we’re looking up now, it’s we’re inside the abdomen Those are all intestines small intestine and there’s come on there : over there and if you look up here, there’s the liver And can’t quite see your gallbladder the colons in the way there. There’s another part of her liver There’s her stomach up there. Her spleen will be way up there and that Pulsating thing up. There is beyond the art abdominal cavity is the heart up there. So she has a very normal internal anatomy And now we’re you can see where dr. Macaron is pushing. We’re going to put our incision We’re looking to avoid to avoid any blood vessels over there So it makes robotics unique is the the two main things are the camera the optical system is three-dimensional whereas most other regular laparoscopy is two-dimensional and Therefore the three-dimensional optics. It’s essentially what like having My eyeballs in a patient’s belly without having my head in her belly, which is a good thing for both the patient and myself but it gives me a much clearer view of the anatomy and then the second thing that makes it special is the Articulation as you’ll see of the instruments in a few minutes, it’s like having a set of hands in the abdomen But yet not having my hands in the abdomen And we’ll go through all that as we go on in the case here in a few minutes So this is another port that we’re putting in. These are eight millimeters in diameter. So they’re fairly small And then we’ll put one Our primary assist poured up here near the stomach. And again, we want to make sure we don’t poke into anything We don’t want to plug into like that Lupul bow. You just saw there And now we’re hooking up a very special insulator called the air seal And it will maintain the pressure at a constant pressure throughout the case And now we’re going to put her in what’s called Trendelenburg And that’s we’re going to allow all this bowel to flow out of the pelvis because the uterus is way down there In fact, I can probably show you that the UK you take her in Trendelenburg There comes the uterus that we’ll be going after here in a minute to take out. That’s good That’s good there and you’ll see here that the bowel should start to kind of flow either pellet there it goes just saw that just flip side of the pelvis so that that’s why we bow prep the patients ahead of time B of that bowel a Little more empty and mobile and this will be the uterus that we’ll be going after in a little bit here And now we’re gonna hook up the primary robotic instrument to get the robot here straight in please Straight straight straight straight straight five four three Two one low I go down well done. So we’ll hook up our cameras and the instrument Here This just usually takes a minute or two, but this is the Going to be our primary controls here And these are the fine instruments that we use this is very fine the Lynch This is where Cotter you’ll go through this as you see my finger size. Here is a very fine little instrument then dr McCarran will put in a similar instrument as the scissors and you’ll see those in a minute The camera What’s that Oh, did we pull out a little bit? Okay. No, we’re gonna adjust just a little bit here And that came out just there okay, yeah won’t you give me that a minute Okay, let you get me the camera Yeah, put that in there man, all right Okay, all right We’ll hook that up again here a little adjustment there in the position of the instruments Okay, now we’re going to put the camera back in and hook it up to the robotic arm And will under direct visualization will watch the sharp instruments go in So again that they don’t bump into anything that we prefer them not to bump into Same thing over here. That’s my side now going in So those are the two instruments that we’re going to work with to do the surgery Gonna hook up some electricity here Then our doctor McCarran is going to come over here and do a sisty and I’m gonna go sit at the console over here the other part of the robot where I will be operating from I’m going to take off my gown. I don’t need that part on other than the mask So this is the other part of the robot over here that will get a look at pretty soon So the robotic controls, I’ll take control the instruments now So these are controlled by my fingers And I have six foot pedals that I’m bouncing the camera on with and we’ll put heat and so on The first thing we’re going to do is look around. So this is her uterus right here This is her cervix Now we’ve put on an instrument onto the cervix prior to starting the camera transvaginal II which will help us manipulate the uterus This is one of the old reason she’s gonna retain her ovaries at this point because she’s a fairly young yet So we’re gonna leave the older that looks normal. This is a fallopian tube and you can see that she’s had a The fallopian tube actually been removed it used to be here they did a at the time of a Cesarean section. They removed her tubes nowadays We used to tie tubes and nowadays what we’ve found in the last ten years or so Is that about a quarter to a third of ovarian cancers? Probably emanate from the fallopian tube So instead of just tying the tubes we take the tubes out. So she’s had her tubes taken out at the time of c-section So we won’t need to do that today So now doctor doctor McCarran yeah there he’s he’s pointing out the ureter Right there And you can watch it comes from way. She’s got very she’s a nice slender patient. So the anatomy is really quite Profoundly easy to see here. This is actually if you go way up here now normally, you know, I do go this high But this is very aura going emanating from her heart. And this is where it bifurcates into what are called the common iliac arteries and then the common iliac arteries will bifurcate again into the internal iliac which supplies the Uterus and other internal organs and an external iliac that will head off into the legs and the lower pelvis and the legs so she’s got very Nice easy anatomy to look at here And there’s the other year the ER is always a bit iam at risk of being compromised during gynecological surgery So we’re very keenly aware of where its course is to avoid injuring it That’s for colon right there That’s the the sigmoid colon descending sigmoid colon going into the rectal there again We don’t want to injure that either now doctor McCarran is gonna put an instrument on this on the uterus to help me manipulate it’s a tenaculum and they see that he’ll get ill grasp and he’ll just be able to move the uterus around for me to make the surgery a little bit easier, so Again the instruments the underwear under ten times magnification when I’m looking in here now You’ll see that we’re getting a coterie effect that’s called bipolar cautery. And we’re going to seal the vessels between the ovaries and the uterus And if we were going to take the ovary out than we would seal the vessels over here But that’s the main blood supply to the ovaries is from the sides. And so By staying on this side the overview will maintain its function the hormones and so from the ovary are absorbed through the bloodstream Not through the uterus. So not having a uterus doesn’t really do anything to the ovarian hormone production and Effects in the body. We just want to make sure this is nice and dry So there’s no maybe no bleeding from it now or later This is called a Maryland bipolar forceps, and this is a model puller scissors over here It also has heat to it if I want it to to show that it has heat there and again You have to be very careful with these Obviously because you don’t want to burn things that don’t appreciate burns like bowel and blood vessels that you’re not playing on the ceiling now we have That part done we got the over that or we separated this is called the round ligament just wanted to support ligaments to the uterus and now we’re going to Seal that one there’s a blood vessel in there. It’s called Samson’s our Sampson’s artery That will separate the round ligament here now And again I’m the one controlling the foot pedal is here the the cautery and The and then my hands are controlling the the two instruments over here so again it’s like having my eyeballs in the pelvis and my hands in the pelvis without having my eyeballs in my hands in the pelvis and So we can do Even better than what we can do on an open procedure Through the small incisions with far less discomfort afterwards less blood loss less risk of wound Complications much quicker healing times back to work usually in our back to full time activity around two weeks Someplace between one and three weeks but average is around two weeks Okay. Now I’m gonna slip behind. Dr. Mccarran’s the instrument here. And again remember we said here’s the ureter running down here. We like to be able to Release the year or so We’re gonna do a delicate pilot procedure here because their blood vessels right underneath here to the uterus. You can see right there There’s a blood vessel and we’re going to see if we can separate that And we’ll bring that just drops the it clears It gives us a clear shot at the blood vessel to the uterus and it drops the year Off to the side so that we cauterize it doesn’t suck the ureter up into our field It’s in our opinion just a anatomically safer way to do the hysterectomy Dr. McKenna and I do a lot of surgery together and our group does a lot of robotic surgery a lot of the partners do Now we’re going to develop what’s called the bladder flap interestingly she’s had Vaginal deliveries and one caesarean section. You can’t really tell much you ever did her c-section in the group it wasn’t me but One of my partners did it obviously did a nice job very little scar tissue there and people all heal a little differently So oftentimes scar tissue is more a function of the person more than the surgeon doing the case But certainly she doesn’t have a lot of scar tissue C-sections do make it a little more common to get to the bladder. The bladder is right down here They actually the Foley catheter is down here and there we put that in before the case But here’s the bladder edge living underneath that we need to get to the cervix Which is underneath the bladder to be able to do the hysterectomy So we have to dissect the bladder off of the the cervix down here without hopefully without injuring the bladder So we’ll take this all the way around here Not a lot of scar tissue though for having had a c-section Frankly yet and we’ll see what’s about the bladder flap here in a minute. We’ll get that part to start with it Looks like your bladder is gonna be nicely down. There’s the edge probably right up in here somewhere. So it’ll be careful there And sometimes you just go layer by layer because you really don’t want to enter the bladder so we’ll just take our time through here And if dr. McCarran as Maya sister jury a lot as well he’s a very accomplished robotic surgeon and If he thinks I’m doing something nice thing about our group we operate with two people Is that if he thinks hey, you’re maybe a little off on your dissection You know, well, he’ll tell me that and we’ll think about it and see if we need to adjust a little bit Here’s a little scar tissue here. That’s why it’s taken a little longer to get through to our bladder to get this down We just take as I say we take our time a little bit deep maybe a little deep there. Yeah. Yeah And we’ll go over here to the side. Sometimes you get to the side We’d rather be a little deep as you saying that rather than too shallow To start with because otherwise if you get to shower you get into the bladder So now we’re finding a layer here and we’re able to get that bladder to get come down. You’ll start sliding down We’re clearly here in a minute. So there’s the layer we want to be the bladder again unit now if I pull it up here you’ll see there comes the bladder right up in there by base right there that that Soft looking thing there. So we’re going to clean that off a little bit better. Yeah And you heard dr. McCarran stay a little deep and this he was right that we were a little deep there One more layer that we want to get through here ya know We like to keep our field nice and clean so that We can the optics are as I said are the best optics that are out there for any type of surgery and But they can be compromised by allowing a little bit too much blood to get in the field. So we’re very Very keen on keeping the field nice and dry. So you’ll see me touch those little spots the bleeding there here and there to keep It nice and dry now we’re gonna this is that there’s a ring underneath here called the Cole ring it’s a blue ring that we put on the cervix at the beginning of the case to help us identify the Anatomy and that will be where we make our incision pretty soon to Open up the top of the vagina so we can take the uterus and the cervix out through it but to do so then we Have to close that we want to clean all this off. This is all essentially para what’s called pair of asthma Issue or vesicle vaginal tissue that’s vesicle is bladder or vaginal if the tissue that separates is the support tissue to the pelvis So we’re going to separate that get that cleaned off and now we’re going to seal the uterine vessels over here I get a little scar tissue from the c-section. So I’m going to try and take a little bit of that down You’ll see it kind of fall off to the side when I do that. But right underneath there are some good-sized blood vessels So we’re gonna try not to get those just yet And if we did it would just cause me to seal them a little earlier but now we have that pretty well cleaned off and now I’m going to seal those large blood vessels and they Sometimes take a little extra cautery to see oh, she’s got pretty good-sized blood vessels there But you can see there’s a large vessel right here. That’s those are called the uterine artery and uterine veins That come from that internal iliac We’ll make sure they seal them and sometimes we’ll lose a little bit after we Cut them and if they do it and we’ll cauterize them some more We’re going to take this all the way into the cervix and then we’re going to go down We’re going to release this whole pedicle area The uterine vessels so that we get those out of our of our way for when we complete. This directed me in a few minutes And again, I know that underneath here there’s some pretty sizeable vessels that are going to tend to want to bleed yet And that’s where you just have to take your time through the vessels. See there’s a little which is okay. Just Kind of see where they’re at. And Seal them as we go. There’s another vessel kind of showing itself now As you get more experience with this those those vessels you just know where they’re at And you kind of go okay if it wants to bleed a little bit, that’s fine. We’ll quickly get it The blood loss is very minimal with this surgery compared to an open procedure an open procedure you’ll lose anywhere from a hundred CCS to 250 CCS on a routine hysterectomy and on these typically if we lose ten to twenty milliliters of blood which we’re surprised so It’s a lot less blood loss And that smoke you see is being evacuated by this filtration system Let’s just smoke from the burning process four main uterine arteries, right underneath her. That’s why I’m approaching it Kind of cautiously right here. It’s right right here You’ll see the artery right there as I’m flicking across it just a bit right there So that’s remain uterine artery that we’re gonna separate here now The Sun will cut it down and see what’s with it You can see there’s the open lumen to another vessel underneath that they have tributaries coming off of it So we’ll just keep you know, you just have to persist at these little things here And see once we get down to the body of the cervix then we will Take that pedicle little further down There’s I’ll show you the mitt but I want to make sure that that uterine artery gets enough attention that it doesn’t bleed Afterwards, you know knock on wood this so to say but we’ve never taken one of these back for bleeding after the surgery right after The surgery at least so it’s a very secure way of doing it Burn the end of that shot. There we go And again this side of the uterus will be coming out in a minute So that loses a little bit on that side, and we don’t worry too much about it This one’s kind of a persistent little bugger there. So we’ll We’ll treat it with the due respect that it deserves All right And we’ll do exactly the same thing on the other side in a minute and that will seal all the blood supply to the uterus here in a bit a Little bit more she has a fairly generous blood supply. I think over the years. I having done this for some years robotics we’ve done for about in our group for about 10 to 11 years now and After McCarron height together at least have done several thousand And you just you did You know some of these universes that that bleed a lot have very generous blood supplies to them as well So it just takes a little longer to get through it Now we’re gonna switch this around and kind of slide off the cervix Right, there is the cervix so it will take some more pedicles here. Remember we cleaned all that off. So now we’re going to Connect the sides to that what we cleaned off underneath the bladder right here You’ll start to see it peel back now as we release the connections Just a little bit will clean up a little bit of this oozing when we see it You can just dry it getting it all nice and dry so that later on And we’ll keep watching it as we finish the case up. We keep watching to make sure we’ve Ascertained that everything’s nice and dry. So there’s no post-operative bleeding problems That’s one of the risks, you know Is that one of those vessel decides to look like it’s nice and dry but occasionally There can be some bleeding usually doesn’t require more surgery, but there can be a little collection of called a hematoma So that sides nice and taken care of. So now we’ll do the same thing on the other side Some pretty good-sized blood vessels connecting over here as well, so we’ll get those This is called the utero varying ligament right there that we’re getting now again We’re going to preserve the ovaries and the blood supply comes from over here. That’s called the infundibulum pelvic ligament So we’ll separate the the ovary now from the uterine body which you did have a fallopian tube That would have been going across there as well So the egg comes through from the out of the ovary into the fallopian tube where it gets fertilized And down into the uterus about right here and hopefully implants as a pregnancy And it’s called the utero varying artery right there you’ll see right There’s a little artery if you look at the end of it right there, there it is right there and we’ll make sure it seals So now we’re gonna do the round ligament on this side And you can see that the gas or the smoke that’s there quickly evacuates this is a very high-tech Evacuation system it’s not perfect. You got it. So it does cloud it up a little bit, but it is a very good system It’s called the air seal. Not that the Name is important, but it’s one of the we’re very blessed at st. Luke’s to have all the the top equipment We have this is the what’s called the SI robot They it’s the third generation of robots Like most computers that every so often they get upgraded in we will we have the upgrades. We haven’t what’s called an X I which is the next Generation and we have new X’s Which is the next generation as well that are going to be installed here after the first of the year, so We have all the upgrades give a little bit bigger field of vision than what I have here That’s kind of running down from the top there, but we’ll get that here a minute So, yes the the all we’re very very blessed in the community here to have access to robotic systems and Very support the Ross hospital is very very supportive of our efforts It’s utilized by urology and by general surgery and by gynecology In some places its utilized by your nose and throat doctors by chest surgeons So it it has a variety of uses. This is all blood vessels yours. That’s why I’m staying very delicate here She’s got a lot of Sizeable blood vessels and we’re just go in there and kind of dissect that away a little bit and again if I happen to get into one of those I try and stay in an area where if I had to I can Quickly come across them and get them if we need to but we prefer to open this up first Again this is intended to release the ureter off to the side a little bit a little bit right here But it’s right against the blood vessels. So we’ll see if I can Get that separated There we go All right So now we’ll go up front here and steal all those big Veblen’s so these are all big blood vessels the uterine artery pedicles They’re a little zoo right there that will take care of And a little persistent and bugging me So now we’ll take a nice big bite there and see if we can seal those blood vessels Again it’s given that it’s a relatively generously as we say a very vascular blest uterus. It’s going to take a little bit more Cautery to do it to take care of this, but certainly we will get it But 99% of the time in our practicum. Akarin our pry my price at least 95 percent Up to as high as 98 or 99 percent of the time we will do All of our major cases Anderson our minor and most of our minor cases robotically as well So it’s a form of minimally minimally invasive surgery and you can also do what’s called straight stick robot minimally invasive surgery and some of People do that and are very skilled at that as well, but the key is to be able to offer minimally invasive surgery to the vast majority of your patients because the benefits are so great from a Recovery standpoint and less complication standpoint. So About 98 99 percent of the time we are able to offer that surgery to our patients Again you can see the large vessels that are all through this pedicle here. We’ll just continue to see all those as we go and Add a little extra blessing here and there to the vessels that seem to need it Now on this side you’ll see me burn less towards the uterus because I’ve got the blood supply on the other side already sealed So once I seal this side, there should be very little bleeding left anymore to the uterus. This had his blood supply separated But you can see everyone’s from want a little vessel decides that it’s not quite happy She just has a lot of good size of blood vessels there one more big artery underneath here that you’ll see in a minute Right. There is a very nice-sized artery So this one this surgery, this is a Some some cases are a little bit cleaner than this one, but she just because she has such big blood vessel I know it looks like there’s a lot of black and some red there, but it’s really 10 to 20 times less what it would be if we opened her up So that’s a big vessel right there that’s a big artery so we’re gonna if Arteries have what’s called a muscularis in them. So they tend to want to stay open, which is a good thing when they’re working But it does make our ceiling oven just a little more challenging at times. They’ll clean off our Sometimes would I say our fork and our spoon? Here, there we go. Get rid of a little bit of char there There just a little bit of something up here. That’s not quite wanting to stay dry, so we’ll go back up there and Seal that a minute There we go and Yeah blood that’s all right there we’ll seal that up and then Add a little extra to it All right, you know we’ll continue on down here You just has a lot of blood vessels now this one I kind of sealed once already and cut it so what we’ll do is we’ll Seal it again and then Resect it back off the cervix here So now we’re gonna swing this around and kind of come right down on top of the cervix and get underneath all these blood vessels Still seeing just a little something over here that bothers me. Like I said, we’re very particular about making sure this is dry before we quit so that She just seems to need a little extra Yeah, it looks a little better Alright I’ll go back over here You can see that we’ll start releasing as well as we go down along the cervix This is that ring thing that we put in called a coal ring names not important, but it defines where the Extent of our dissection down here is going to be that’s the very top of the vagina We’re almost to a point where we don’t need to do any more a dissection here and things have dried up nicely. I know it Looks pretty impressive of all the the char there But that’s just part of the ceiling all those blood vessels and making sure they don’t be later on What do you think going up looking halfway decent maybe a little bit right there, yep That partner is being very quiet up there right now because I got I’m jabbering away here. It’s going very smooth Again we’re just making sure this is called the bladder pillar right here We’re just making sure that we seal those all those blood vessels and I think that’ll do it All right, so now we’re gonna do is call now we got all the blood vessels seal other than that one We’re going to do what’s called a copepod ami, that’s where we’re going to open up the top of the vagina that side looks good So again, this is bladder right down here. So we don’t want to injure the bladder That’s why we dissected all that off there though blood vessel. I think right there I could use a little touch and now we’re gonna use this too This will be right at the junction of where the cervix and the vagina Come together And you’ll see that blue ring that I told you about before that we put in there’s the top of the blue ring That kool ring that just defines the top of the vagina And where we want to take the cervix out And the uterus together and we’ll take it out through the vagina in a minute. Then we’ll sew that all back up again I’ll show you in a few minutes. So just make sure everything’s nice and dry here again. It looks very good and Will come right around the corner here And we’ll go to the other side And while we’re doing this, I’m always looking over here to make sure that I’m happy with the how dry it is double triple check everything This she’ll stay overnight tonight and go home tomorrow some patients go home the same day and something most patients stay overnight one night I just feel that they do a little better by spending the overnight Reich and give them some medications to help With the discomfort from the surgery let them wake up from the anesthesia. It’s done under general anesthesia we have a wonderful group of Anesthesiologist in the community. We’re very blessed that way as well that have really helped along with the robotic program These are called the uterus sacral ligaments are part of the support to the vagina But you can see we’re leaving most of us of though That’s one other advantage of Robotics that we’re leaving those ligaments attached to the vagina helps – you know, there’s a somewhat of a Feeling that you take the uterus out things are gonna fall out inside there A lot of women will ask about that One of the beauties of the robotic approach is that we leave those ligaments attached to the top of the vagina So I found that support stays as good as any hysterectomy I’ve ever seen Just one more little burn there You know, we’ll just take a quick look around and make sure everything is dry before I take out the instrument so we’re gonna rip that once the animals got just a little after pulling on things out just a little bit of Booze to us. So we’ll just touch that one up. They said she has some pretty impressive arterial arteries here And they’ve just taken a little extra attention That’s why your uterus is bleeding. And one of the reasons why your uterus probably bleeds so much as well. She has very generous blood supply to it I think that looks pretty good How about that side? I think then we see that little edge right there on Right here. Let’s just touch that one one more time, too There we go Yeah, that looks good Yeah, it looks good there very little blood. Some of us just statistics, maybe 10 to 15 milliliters So now we’re going to switch instruments out. Dr. McCarran will suck that little bit out And then we’re gonna put a what’s called the sponge in the vagina hear That right now what the vagina is open, this is actually the top of the vagina and we’ll put It we’ll put a blockade a little sponge in there with a glove in it That will keep all for the air from flying from releasing through the vagina while we sew the top of the vagina And we’ll take that out at the end of the case Okay, very good, let’s go ahead and sew So now we’re going to close the vagina And then the case will be complete after we take the instruments out and close those little incisions on the abdomen These stitches in the vagina are absorbable stitches. So they’ll go away over the next six to eight weeks Typically I restrict patients from Sexual activity vaginally at least for about eight weeks afterwards to make sure it all heals up before any stress to my suture line Okay, so remember all that dissection we did we’re gonna get it doesn’t look like the we dissected that much Here’s the bladder right here. So we don’t want to stitch the bladder So we’re gonna go right next here to the edge get a nice big bite of that, but that’s tissue there The key to not havin to having this heal correctly as to make sure you get nice big bites of this tissue Which what we’re gonna do so These are called needle drivers that we’re using here right now And we’ll go right through that ligament. I told you about another way of really Supporting the top of the vagina is to get a good bite of that the ligament there These will be what are called figure of eight stitches There are some people who do what we call a running stitch kind of like a seam when he head in Sewing it From side to side and that’s certainly reasonable as well And we’re very cognizant to get it where the ureter is you can see it right here Trying right along underneath the uterine vessels, but we’re medial to the middle of that so we know we didn’t get the order This material is a Long long acting does or at least a delayed absorbable suture. So it takes a while for it to to go away. That’s good We want that to heal So we’re going to tighten that up nicely here It’s relatively slippery suture, so we’ll put a fair number of throws into it as I call it This has a scissors on it, so there’s the suitors will cut through that dr McCarran will give me a new needle and then he takes out the old suture Having a good assist is a huge part of this procedure to make it go well and As I said our group tends to operate with two surgeons Which I think is a huge advantage to the patient and it’s also an advantage to the surgeons it’s a much more relaxing procedure knowing that you’ve got somebody as good as you good or bad I guess but In the in the room to help you with the surgery That’s a very thick piece of tissue here so that you got another set of eyes to make sure the surgery is going well Get that to come through Really thick tissue there There we go So it get a nice big bite with that uterus sacral ligament that we have that’s that ligament right here I’d like to sell with either hand That’s why we have Neal drivers on both sides one’s a little bigger than the other that’s called the mega. The other is the large Needle driver again. We’re gonna get all this tissue compressed in the suture and a figure of eight stitch a wonderful Staff or a DaVinci team. We have the best teams around here We have had over the years people from all over the country come through to see how good our DaVinci team is At about six hundred and forty or fifty surgeons from 43 states. I believe come through someplace in that range over the last ten years and as far away as Alaska in the wintertime, not ever sure why a person would fly from Alaska to Iowa in the winter, but Anyway, so our team is renowned Around the country how good they are again. Very blessed That’s the bladder edge right there. So again, we don’t want to get the bladder We’ll push it back a little bit and get a good Bite of the vaginal cuff as we call it Usually put about five stitches in here Hmm tighten it up a little bit that stops any bleeding and it really Makes the edges so that it heals kind of like an incision anywhere Put some stitches in to bring the edges back together so that the body can heal it It’s still a mate considered a major surgery what we’re doing here, but it’s just done in a uniquely elegant way in my opinion It’s one other than the 30-some years of me doing practice practicing on exceptions and gynecology It’s one of the greatest advances I think I’ve seen in women’s health care is the advent of the DaVinci robotica surge surgery equipment Put one more in the middle there after this and then We’ll do what we call a wash just to kind of clean things up all the patients get a dose or so of antibiotics Because obviously we’re going into a non sterile area into the into the vagina We certainly do prep all that with Iodine preparation in the vagina and some other preparation on the abdomen to reduce the risk of infection So infection is relatively on Tama, but we do what we can to prevent it You see a fish at doctor McCarran is as soon as I’m done the next suture is there already Very little wasted motion as we call it you know the shorter the procedure the less anesthesia time that the patient has and there’s the advantages to that and Being tilted down on her head just a bit it’s you know, I’m not a natural position so though if we can minimize the amount of time that the patient is to Tilter like that by being efficient that’s to the patient’s advantage We’re making sure that we get the vaginal mucosa here that’s that shiny stuff right there Make sure we get the edges of that. So that makes it heal better That’s why I’m making going down in there making sure we get that try and get the sutures approximately, uh evenly distributed So we have three robotic units at st. Luke’s hospital here there’ll be as I said the two x’s the latest generation and the X I those are the Latest generation of robots available. So we’re technologically as advanced as anybody around And so that’s the hysterectomy and we’ll look to make sure everything’s nice and dry now kind of look around a little bit We look at the ureters again right here is a your order It’s happy and you’ll see if I if I say hi to it like that. He’ll move you can see that what’s called peristalsis That’s urine going through that if you get up close, we’ll see it on the other side as well Here if you look real close at the ureter here You just watch what it does when we move when we push it a little bit Typically, you’ll get a little peristalsis there. This one doesn’t decide it doesn’t want to show off right now There he goes. Dr. McCarran got to go. You can see that’s urine moving through from the kidneys to the bladder So we’ll clean things up and finish up here Very good You drop the pressure to eight will do what’s called a low pressure test just to make sure once the pressure in her belly goes down That that doesn’t allow any small little veins to open up. So you’ll see that thank you. So The pressure now down to eight instead of fifteen where we were before so we have the pressure We’ll just see if there’s anything using it’s nice and dry Everybody’s happy and we’re ready to take the instruments out now and close the little incisions So I’m rubbing back in with a bacterial static jelly her gel that we put on So all the partners within our group do some form of minimally invasive surgery we’re all advocates the minimally invasive surgery So it’s not just myself and dr. McCarran We just have chosen to focus on robotics and they’ve been very pleased with that Yeah, we’re just gonna put a little bit of fluid on the tummy to help clean it off a little bit here And then we’ll take out the last instrument here And close the incisions we put in a Absorbable sutures underneath the skin and it will put some steri-strips across there are some superglue whatever We feel like might be best doesn’t really matter frankly And then from here she’ll go into the recovery area for maybe 45 minutes to an hour and then she’ll go up to the floor We look we feed them right away they don’t have the Right away, but we feed them very soon afterwards up at the floor So we don’t build the old way of not feeding patients after surgery particularly this minute invasive surgery. We don’t do that pain meds She’ll get like a potent motrin called tore it all through the IV and then she’ll get offered Just an oral pain pill every four hours or so. Sometimes they need it. Sometimes they don’t She’ll be up for running around yet this evening and by tomorrow morning, she’ll be ready to go home and I said we don’t restrict them very much. Do you know you just want them to be a little? Cognizant of the fact they had major surgery So they don’t necessarily go out and try and run a half marathon in the next week I’m usually make sure they give them a few weeks to recovery before letting them do a lot of the heavy duty exercising again but not the old six to eight weeks that goes with the Open procedure. So it’s a again a far Gentler kinder wait, I guess the still to do surgery in our opinion much more elegant We use 30 of Archangel They said multiple specialties are doing robotics now, it’s really rewarding to see all the different specialties that are There doing it urology is actually I have to give them credit. They’re the folks that started the robotics program at Saint Luke’s so the robotic group in town With PCI has does a lot of robotic surgery and they’re very very good at it And I said now the general surgeons are doing some of their procedures as well, so it’s a it’s a and it’s a very Forward-looking company is called intuitive They are worldwide company They’ve done a nice job with the technology Anything you’d like to add dr. McCarran. I was just thinking not much sounds all good We didn’t use the vessel seal there Yeah, they there is another instrument. We did not use called the dr. McKenna’s mission was called a vessel sealer And in this case, actually the vessel sealer might have been somewhat beneficial our just a little easier But it’s a single-use instrument. So therefore it adds An oil painting at least for as many as we do We feel like it adds extra expense to the patient into the system that’s not necessary, but it is Okay to use it too. It’s just that we feel like we Don’t really need that. We try and stay cost-conscious as well. But you have to provide the best care available to the patient Putting little steri-strips on now these will stay on for about a week To two weeks and then they’ll get peeled off by the patient or come off And those stitches we put in will dissolve underneath the skin and so that’s the completion of the case and we just have to take the Put that Foley catheter out of the bladder and she’ll will wake wake her up here in a few minutes and she’ll move over to recovery and go up to the river floor to her room as I said and go home tomorrow, so Thank you. And again if you have questions about it check with st. Luke’s or with obedient associates And we’ll be happy to answer those questions Experience matters when it comes to choosing where you have your robotic surgery the team at st Luke’s and Cedar Rapids performs more robotic surgeries than any other Hospital in Eastern Iowa and is a robotic training center for surgeons around the nation learn more about robotic surgery at st Luke’s at unity point o RG slash robotic surgery

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97 thoughts on “Watch a robotic hysterectomy at UnityPoint Health – St. Luke’s Hospital

  1. I'm preparing for such a surgery, and this was very helpful. Granted, I needed a break after the first 6 minutes. You wake up with little BandAids on your belly and have no idea what your body experienced. I'll definitely follow Doctor's Orders to rest and go easy on my abdomen after my surgery. Thank you for showing calm and skill from each member of your team.

  2. Thank you to the patient that allowed herself to be filmed! Really helped relieve some anxiety about my up coming hysterectomy.

  3. This is so interesting and fascinating. I'm going to the doctor this month cause I'm having issue with my lady parts as well. This might be a option and if so, I don't feel anxious about it anymore because of this video. Medicine and Science these days is amazing!

  4. I had this surgery 3/4/2019. I was in the Hospital for a day. 7 days after the surgery I awaken to see I was sleeping on my stomach. My incisions healed very well. I wanted to go to work after one week of the surgery. My Doctor said NO! At least 4 weeks off. I feel wonderful!😃😃

  5. I just had this done March 28th 2019…By God's grace,I did great! Lil to no bleeding at all…I was up walking the next day…I slept on amd off the day of surgery…It wasn't as bad as I thought…I'm just sore

  6. I just had a robotic hysterectomy and this is a great video. Wish I had looked at it before my surgery. Thank you VERY much for sharing. After the surgery I was wondering what the end positioning of the ovaries would be. It's nice to see why I'm having to rest so much and be careful about with regard to putting too much pressure on the abdomen while recovering (not just so the vag cuff can heal but also so I don't pop cauterized vessels which must heal as well). Now I'll also have some good questions to ask my surgeon at my post op appt. I would also like to thank the women who allowed for this!!!

  7. In my case I am having this surgery done middle of next month. I am worry because thru all this process to prepare for the surgery I found out I have a blood disorder. I bleed out. Very concern about it because my blood dont coagulate.

  8. Question is it safe for a patient who has had a tummy tuck to get this type of procedure the belly wont bloat much with am tummy tuck how would that work if they cant bloat the belly and see in the uterus?

  9. I had this on a Thursday. Drove home on Friday. Back to work on Monday. It was like nothing happened! Literally zero discomfort.

  10. I had this surgery 24 days ago and I was up walking around the first day k I was working the 2nd week. No problem at all. Wonderful surgery. Not much pain

  11. I had this done 3 yrs ago and it went well! Only thing that was uncomfortable for me was the gas they put in the stomach. The discomfort didn't last long tho! Happy I had this done!

  12. Just had this done today, I can say that I'm in little pain. But every thing went well. I'm in the hospital right now I should be home by tomorrow. And 8 weeks of recovery.

  13. wow amazing! it's neat that a new technology is already working so smoothly. what would have improved with the vessel sealer? how does it seal?

  14. i had this exact same surgery exactly 2 weeks ago today, except they did a cystoscopy as well.Not sure why but they did. i was definitely up and moving quickly and off narcotics in 1 week or less. Only issue i had was diminished sensation to my right groin and pain during my urine stream, that is in my lower bladder area. I’m hoping it will subside

  15. My sister just had this done a few days ago. These doctors are so amazing at what they do!! Thanks for sharing!! 👍

  16. My mom had first laparoscopy and doctor makes some mistake they cut one of nerve by mistake and bleeding doesn't stop at all after that immediately they started doing hysterectomy and it is so serious operation she is near to die at all everything is fine but she fill very weak day by day and some gastric problem

  17. There has to be another way to create life a less painful natural way..this womb thing degrades the female quality and experience of life …now i would still like to carry a baby in my stomach but periods no..i wish i was like a kangaroo

  18. I had this done on Tuesday and today marks 4 days post op and I am doing better than expected. A little sore but I'm glad I got my stomach binder. It really helps with supporting my stomach. It's cool seeing what the surgery looks like. Kind of glad I waited until after my surgery to watch this video though.

  19. Typical surgeons. No mention of
    – reduced blood flow to the upper vagina resulting in uncomfortable dryness with sexual intercourse
    – removal of half the suspensory tissue that protects against pelvic organl prolapse (POP).
    – removal of bladder fascia with inherent nerves leading to incontinence issues later.
    This woman would likely have reduced uterine bleeding via a healthier diet and other lifestyle factors that reduces excessive stimulation of sex hormones.

  20. How incredible! The commentary was very interesting and clear, even though I do not have a background in the medical field. Thank you for sharing this!

  21. Her intestines fell out through her vagina after the patient arrived home. Almost 90% of the hysterectomy done with the davinci ended in a woman being vaginally gutted.

  22. I have had this surgery I did not have less pain I had plenty and they ended up reopening my c section scar this surgery is pointless, everything they do to you before this surgery is very degrading in regards to a patients privacy its not a minimum invasive surgery it is a degrading surgery and its not fair to not properly inform your patient about what your going to do and no students should be allowed to watch you without the patients verbal and written consent its a matter of time before someone slaps them with a lawsuit!!!! These surgeries cost a lot of money I did my research online the reasons more and more doctors are doing this is so your insurance companies pay so they can afford to pay off these robotic machines here it is a money making business off of you as a patient always do your research don't given in so easily!!!!!!

  23. I had mine 4 days ago and the pain went on day three hardly any pain to be honest.. Only when I had wind really. Feeling good although tired and sleeping early. Please don't be scared if you go for one it's such a wonderful op.

  24. I endured severe suffering almost all the time because of one little fibroid present in my own uterus. However I am happy that at last I stumbled upon this fibroids treatment “Kαmwοt Sοnο” (Gοοgle it). I`m surprised there were no more suffering and indications of the disease by the 3rd week. .

  25. Watching this helped relieve anxiety for the unknown, my daughter is 50 and having a hysterectomy today, im not able to be with her so this helped a lot.

  26. Had this surgery on 7/15/2019. I can say there was no pain just gas discomfort. I stayed overnight and went home the next day. No spotting and eveything was fine. Couldve went back to work the 2nd or 3rd week, but I just wanted to rest.

  27. I had a laparoscopic robotic assisted hysterectomy August 5th, I really didn't have too much pain afterwards. The only pain I had was pain in my upper back and shoulders. Found out from the pathology report that I have cancer
    I start 3 treatments of radiation starting September 25th

  28. I closed my eyes for a couple minutes woke up and the procedure was over, it's like riding in a car you think you fell asleep for a couple of minutes you wake up and you're in another state

  29. It’s Amazing 😉 How These Top Well Know Surgeon 😷 Do These Surgery’s With These Robotics Nowadays Back In The Day’s It Was Very Different Back Thankful Time’s Have Changed Now In The Operating Room’s

  30. What a nice calm demeanor you have, very thorough explanations of everything- thanks to your patient and your entire team for sharing. You guys work like a well oiled machine

  31. I was after that week identified as having 2 little fibroids in which placed an enormous pressure on my own bladder. By using conscientiously for Four weeks this fibroids treatment solution “Kαmwοt Sοnο” (Gοοgle it), I’d seen a lot of development around 70% in my fibroids had shrunk. Later after seven weeks of constantly sticking to the treatment plan, I had taken an ultrasound examination and noticed that the medium-sized fibroids are eliminated. .

  32. I just had my hysterectomy two weeks ago. Went great, feeling great. My surgen said i could eat whatever food after i wake up. For some reason they had me down for clear liquids only. I told them i was aloud but they refused to give me any food except jello and broth. When my surgen came into check on me she wasnt happy they didnt feed me. I didnt eat for like 36hours….. my hunger was worse than the soreness of the procedure lol

  33. I had this done Aug 20th. I've had nothing but problems..had a huge amount of endometriosis he said the worst case he's ever seen plus cancer. I just got outta bed anf it ripped the vagina cuff. Had to go back for a second surgery to fix. I'm still sore around my incisions and still spotting. How long am I supposed to be sore around them

  34. I just had surgery 9/16/19. I am doing great just sore. My doctors had a big challenge because I had lots of scar tissue. God blessed their hands and I came through with only an overnight stay in the hospital. God bless Dr. Crews and his staff in Mississippi.

  35. My respect to this doctor and all team i got this kind of surgery this tuesday 10/15/19 in las vegas sunrise hospital but my sugery is going to be a total hysteroctomy ,thank for share this video

  36. My doctor is heavily suspecting I have endometriosis. I don't want kids, ever. I have autism, I don't wanna pass it to my children because the world is still very cruel to us, and because of my autism, it makes bonding with children damn near impossible and I can't stand them for long. I'm not meant to be a mom, and I'm 100% okay with that. But because I'm only 22, I highly doubt they'll actually listen to me when I say I want a hysterectomy because I don't want children. They'll pull the whole "Ohh you're still yoouuung you'll change your miiind". No, I'm pretty fuckin' sure I won't. And if I do, there's this amazing thing called: Adoption.

  37. Applying this fibroids treatment plan “Kαmwοt Sοnο” (Gοοgle it), results can be seen soon. All of my signs and symptoms was gone away in just Four weeks. Additionally, there were no more signs of my big .2 centimetres and 8.5 centimetres fibroids.. .

  38. Had this procedure done this past Monday(October 21,2019) I'm still recovering but this is heaven sent. Zero pain. I was so afraid for no reason. Dealt with stage 4 endometriosis without ever being diagnosed. My doctor said i was one of the worse cases he's seen. If i would've known this existed earlier i would've had it done 5 yrs ago when my cycle became unbearable.

  39. I am having this next friday… my uterus started cramping as I was watching this 😢…i think she offical knows whats to about to go down… I love my uterus but she is trying to take my life… and zhe just forgot I was her ride to the party . I have had 4 myomectomy and my uterus has seal to my colon… anemic due to many countless fibroids largest the size of a baseball … my uterus normally 4ins now 12 inches across…madness
    I trust God but getting a bit nevoruse because it's not a normal anatomy my drs going into like thos one.

  40. Of publications I`ve check out on my newly found fibroid ailment, this fibroids solution “Kαmwοt Sοnο” (Gοοgle it) is certainly the most informative. By using the plan recommended in the treatment plan has provided unbelievable results. Without a doubt, this is valuable. Fibroid left within my uterus is 10% mainly and what’s even more amazing is I am expecting a baby now for 3 weeks. .

  41. Well I think I have to throw up now. I have uterine cancer and now I'm so scared to have this operation done. Thanks for showing it. I just don't have the support of a family to get me through this. I wonder if I will die if I don't have it done. Maybe dying is better.

  42. I had my hysterectomy done on Oct 21st …. Everything went well and I'm returning to work after 4 weeks ..light duty of course😊 My doctor did an amazing job!!! I'm feeling like myself again

  43. I had a full hysterectomy thank god i never had a pain pill i never hurt but i do recommend ladies to talk to someone counselor etc idk if it was me or what but i have never had children and hearing the baby announcement ever so often was hard i had my hysterectomy due to cancer thank god im cancer free now

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