Robotic Hysterectomy


Meet with Ulas Bozdogan, MD, FACOG

Endometriosis & Fibroids Specialist located in Hackensack, NJ and New York City, NY

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You may have seen pamphlets—even billboards—touting “robotic” hysterectomy. It is usually accompanied by a smiling patient, which is presumed to be the “after” of a before-and-after between a woman who needs a hysterectomy and one who has had one. This commercial is designed to engage your attention but provokes questions:

  1. Is that smile genuine?
  2. Is robotic hysterectomy just a marketing gimmick?

The smile is genuine.

Robotic hysterectomy really is everything the come-ons imply. That smile may not be there the first 12 hours after surgery, but it may very well be there the next day. This is because the Da Vinci robot, well established and time-tested, offers minimal tissue manipulation inside your pelvis.

Your body does not like to be invaded or have its pristine, untouched tissues handled and manipulated. The human body’s ever-watchful immune system guards your insides very aggressively, with an immediate immune reaction against any invasion—an inflammatory response. Inflammation releases pain-mediating neurotransmitters that were originally designed—not for post-operative surgery responses—but just to let you know that, for example, an incident between a cavewoman and a mountain lion is not a good idea. This warning signal has not changed in thousands of generations. Your body, even today, still thinks you’re that cavewoman, not that patient paying her co-pay in Out-patient Admissions.

Just like a cat scratch (compared to a proper lion mauling) evokes a only a small inflammatory response, the minimal handling of tissue via the Da Vinci robot results in very small inflammatory responses compared to open abdominal surgery or even the kinder, gentler laparoscopic surgery which was considered the ultimate approach. Until the Da Vinci robot came along, that is!

It became evident that even the laparoscopic surgery which heralded the brave, new world of out-patient surgery had its limitations. For instance, there was only one view—downward from the navel down into the pelvis; also, the surgical poles used to manipulate tissue were not jointed like the hands of an experienced surgeon and therefore not anywhere near having the same dexterity.

Having a Da Vinci Robot is no cheap come-on or marketing gimmick.

The hospitals and the surgeons that offer it are offering their patients the state-of-the art in outpatient surgery. Surgeons like Dr. Bozdogan of EndometriosisNYC know the results because when one has done over a thousand of them like Dr. Bozdogan has, the results are clear: no one can in good conscience go back to the outdated methods. Such a surgeon also demonstrates an aptitude of being on top of the latest developments and techniques and even developing them for other surgeons.

Enter, the uterus. (Actually, EXIT the uterus.)

A hysterectomy has always been considered a major surgery. Modern gynecology has offered many medical and hormonal alternatives to removal of your uterus, but when there is no other way to end a serious problem you want a surgeon who is very familiar with the procedure. GYN surgeons train for years after medical school to hone their techniques.

What makes it a major surgery are the concerns so disturbingly spelled out on the informed consent you will be signing before the surgery can begin:

  • Infection.
  •  Bleeding.
  • Damage to other structures.

Infection: your insides are sterile. Open up the world to them, and bacteria can seed these areas and cause life-threatening infections. True, this is what antibiotics are for, but in today’s world of resistant germs, the less exposure to the world the better. With the Da Vinci robotic hysterectomy, the incisions are cosmetically small, but this also affords very limited exposure to outside bacteria. Size matters, and the larger the incision, the greater the chance of getting an infection; the smaller the incision, the more this complication is unlikely.

Bleeding: a major consideration in removal of the uterus (your womb) is attention to the blood supply to and from it. It’s tricky in that these blood vessels run under the floor of the pelvis, sneakily out of site. Yet, they must be separated from the organ they supply if that organ is to come out. Whether your ovaries remain or not, that’s another blood supply that requires respect and attention to detail. True, blood loss is what they make blood banks for, but there can be no arguing with the less blood needed, the better; and this is the goal of the meticulous surgery the Da Vinci offers.

Damage to other structures: the prime directive for doctors is the traditional motto, “Above all, do no harm.” Besides blood vessels, other things run under the floor of your pelvis, the detachment from which is necessary for your uterus to be removed during a hysterectomy. Important things are running very close to the uterus where all the action is going down. A paired set of ureters, those tubes that run urine from the kidneys to the bladder, running under the floor of the pelvis (again, out of site) run very close to the body of the uterus—within about a centimeter. Damage to them could cause a serious problem with the anatomy of your urinary tract requiring subsequent surgery to repair.

The Da Vinci robot

The advantages of the Da Vinci robot are immediately evident with surgical procedures like a hysterectomy. The hazards above are mitigated such that complications, although not impossible, are substantially unlikely. The small incisions, besides emphasizing a cosmetic sensibility, also limit exposure to germs dying to get in. Using 3D stereoscopic views with magnification settings and with a 360° potential to approach over, under, or around structures, the addition of meticulous and skilled dissection and traction of tissue means the Da Vinci robot is the unsurpassed method of performing a hysterectomy, taking a dangerous week(s)-long stay in the hospital, fraught with pain and considerable loss of income, to an out-patient procedure that can see you at your normal day-to-day activities within days and back to work in two weeks.

At EndometriosisNYC, Dr. Bozdogan uses the Da Vinci as his “go-to” method for giving his patients what they deserve—only the best in cosmetics, pain-prevention, and fast recuperation. After all, even with a hysterectomy…you have plans!

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