Scalpels, Suture and Robots- A Hysterectomy Guide

by: Dr. Jacqueline Kohl, MD, MPH

Surgery can be scary. Even as a surgeon myself, I was anxious before having surgery myself for the first time. Knowing my surgeon was thoughtful about technique and used an individual approach put my mind at ease. If you are having gynecologic problems and thinking about a hysterectomy you can read more about the procedure and options below.

What is a total hysterectomy?

A total hysterectomy is removing the uterus or womb and the cervix. This contrasts with a supracervical hysterectomy, where only the uterus is removed, and the cervix remains in place. Supracervical hysterectomies are less common. Ovaries and fallopian tubes can be removed at the same time or left in the pelvis. Often when women say “partial” hysterectomy, they have had a total hysterectomy, but still have ovaries. I often offer to remove the fallopian tubes because it can help reduce cancer risk with minimal added risk. I rely on shared decision making with my patients to weigh the unique risks and benefits of keeping or removing ovaries

What are some reasons to have a hysterectomy?                 

There are a variety of reasons to have a hysterectomy. Heavy periods, fibroids, endometriosis, pelvic pain and risk of cancer are all possibilities. Many of these conditions can also be managed with medications or less invasive surgery, but sometimes removing the uterus and possibly the ovaries will provide the most relief.

How can a hysterectomy be performed?

An abdominal hysterectomy is performed through a large abdominal incision and the uterus is removed through the abdomen. This can leave a low horizontal scar like a bikini cut or a vertical incision up to or even above the umbilicus. A vaginal hysterectomy is performed by making an incision in the vagina and removing the uterus without any abdominal incisions. In laparoscopic hysterectomies, a small incision is made, usually near the belly button, and a camera is inserted. Several other small incisions are made on the abdomen to perform surgery, and the uterus is removed through the vagina. A robotic hysterectomy is a type of laparoscopic hysterectomy. Laparoscopic incisions are made, and robotic instruments are used to perform most of the procedure. Vaginal, laparoscopic and robotic hysterectomies are all types of minimally invasive gynecologic surgery.

Is robotic surgery safe?

Any surgery has risks, and robotic surgery is no exception. However, the robot does not “perform” hysterectomies, or any other surgery. In robotic surgery, the surgeon is still performing all aspects of the surgery. Instead of standing beside the patient, the surgeon sits at a console with controls and a 3-dimensional screen. From there, she can control the instruments attach through laparoscopic incisions while seeing the anatomy clearly.

Why use the robotic system?

My goal is to offer the procedure that is least invasive and safest for each patient, depending on her history, examination and risk factors. The robotic surgical system is a tool that allows me to offer a minimally invasive approach to more women who may not be good candidates for vaginal or laparoscopic procedures because of scar tissue, a larger or irregularly shaped uterus, or other anatomic challenges.

Considering a hysterectomy? Schedule a consultation today to discuss all options (surgical and non-surgical) and to explore the best treatment plan for you.

Author

Dr. Jacqueline Kohl M.D. Jacqueline Elyse Kohl, MD, is an experienced obstetrician and gynecologist at Philadelphia Women's Health & Wellness in Philadelphia, Pennsylvania. Dr. Kohl earned her Bachelor of Arts in psychology in 2006 at the University of Pennsylvania. In 2011, she earned both her master’s degree in public health as well as her medical degree from Thomas Jefferson University in Philadelphia, Pennsylvania. Upon graduation, she began her residency in obstetrics and gynecology with Abington Jefferson Health, serving as Administrative Chief Resident from 2014 to 2015. After spending two years working at the Hanjani Institute for Gynecologic Oncology in Abington, Pennsylvania, Dr. Kohl developed a special interest in gynecologic surgery using a minimally invasive approach, which she carries into her medical practice today. Dr. Kohl has also taken her medical expertise abroad by assisting with labor and deliveries at a district hospital in Rwanda. Dr. Kohl is a member of the American College of Obstetrics and Gynecology.