Robotic Hysterectomy

Living Life Again

Kathleen Morrissey loves cycling on the Blackstone River Bikeway, but her heavy menstrual bleeding caused her to give up the hobby. Even trips to the grocery store and driving around her 13-year-old daughter became stressful events.

“It was really painful,” recalls Kathleen, 52, of Douglas. “I was bringing a change of clothes everywhere I went. In January of 2016, I got my period and it basically didn’t stop. I had a large polyp that had grown on the inside wall of my uterus. I’d have my period three weeks, with a day or two off, and then it would start again. It limits your options when you always have to be near a bathroom.”

Depending upon an individual’s circumstances, possible treatments that, at times, help alleviate the heavy and/or continuous menstrual bleeding some women experience include prescribing birth control pills, removing polyps, or attempting to shave out a fibroid in the cavity of the uterus, relates Mary Kay Myers, MD, FACOG, an obstetrician/gynecologist in Milford and Kathleen’s doctor. “Better than 75 percent of the time, a less aggressive procedure will work,” Dr. Myers notes. “Most patients prefer to try something else first before having a hysterectomy (surgery that removes the uterus) as they are usually concerned about surgical risk and recovery.”

Before coming to Dr. Myers, Kathleen had undergone endometrial ablation, which burns the lining of the uterus and causes scarring that prevents the tissue from re-generating every month. Unfortunately, her improvement was short-lived. Dr. Myers then attempted to insert a Mirena IUD, a progesterone-containing device that thins the uterus lining hormonally. In this instance, the device wouldn’t fit correctly into the lining of the uterus because of the ablation, says Dr. Myers. Before deciding on a hysterectomy, Kathleen underwent a D&C, a diagnostic procedure to remove tissue from inside the uterus and check for cancers and precancerous changes. The test didn’t show cancer, but her bleeding still persisted.

Having exhausted all her options, Kathleen decided it was time to undergo a hysterectomy. Fortunately, Kathleen was in the hands of Dr. Myers, a highly skilled robotic surgeon who is on the medical staff at Milford Regional where patients have benefitted from the leading edge advancements of the da Vinci Surgical System since 2013. This sophisticated robotic platform expands the surgeon’s capabilities and provides a minimally invasive approach to otherwise open surgery.

“I can’t say enough about how the robot has made minimally invasive surgery accessible to patients who previously would have required an open procedure,” notes Dr. Myers. “It’s great that a community hospital like Milford has that technology and the experienced surgeons who can use it. Recovery for an open procedure is four to six weeks, while with robotic-assisted surgery, more than 90 percent of patients will recover in one to two weeks.”

Because Kathleen had abdominal surgery three times in the past—two cesarean sections and an appendectomy—there was the possibility of excessive scar tissue which increases the risk of surgical complications. Dr. Myers wouldn’t know if scar tissue existed until Kathleen was on the operating table; excessive scar tissue increases the likelihood of converting from robotic—assisted surgery to open surgery.

“Having a hysterectomy can be a difficult decision,” Dr. Myers says. “I’ll take a piece of paper and draw a picture, walking them through the entire procedure. You can never completely allay someone’s fears until they wake up and they’re fine, but a thorough description and explanation does remove the mystery and go a long way to helping them feel more confident. ”

After thoroughly discussing surgical options with Dr. Myers, Kathleen was eager to move forward. “I just really didn’t want another abdominal surgery recovery. . .I knew what it entailed,” she admits. “Dr. Myers prepared me for the worst, while I hoped for the best. If she had to open me up, I would’ve been out of work for a month to six weeks with no driving for a month. I was psyched when I found out that I was able to have the robotic surgery.”

Kathleen’s hysterectomy was scheduled for December, 2016.

Dr. Myers starts the surgery by making a small incision above the patient’s belly button. She positions a small probe to fill the abdomen with gas and then places four ports about the width of an index finger. “The ports are basically like a passage to put the instrument in,” she relates. “The central one above the belly button has the camera in it.”

Once the instruments are connected to the ports, Dr. Myers sits at the surgical console and looks through a viewfinder, where she controls two instruments and the camera with the robotic arm. A foot pedal allows her to move the camera.

“It puts a lot of the control solely into my hands,” she says. “I need my surgical assistant a lot less for a robotic procedure. If someone else is controlling the camera, you’re always trying to get them to hold it where you want to look, so it’s nice to be able to have control of that yourself.”

In preparation for the possibility that Kathleen’s robotic-assisted surgery could be unusually complex, an oncologic surgeon from Brigham and Women’s Hospital served as Dr. Myers’ assistant so that, if necessary, they could perform the more complicated procedure together. However, Dr. Myers was relieved to find minimal scar tissue, which meant she could proceed with the surgery robotically.

Kathleen had her uterus and cervix removed, but kept her ovaries intact. Dr. Myers explains that there are pros and cons to keeping the ovaries and that it depends on the patient’s preference and medical condition. “If the procedure is for cancer, the ovaries are always removed,” she states. “Removing them reduces the risk of ovarian cancer, so if you have a family history, have had trouble with ovarian cysts, or are older, we would discuss removing them.”

Patients who retain their ovaries, like Kathleen, go through a natural menopause as well as receive bone density benefits, says Dr. Myers.

Following robotic-assisted surgery, most patients leave the hospital the same day and are advised to eat light and rest. They return for a follow-up appointment in about a week. Kathleen was home by 5 p.m. the day of surgery and recalls that she was back on her feet and not taking anything stronger than Tylenol within two days. She went back to work in a week and a half. She has resumed long bike rides, crediting Dr. Myers and the hospital staff for giving her a much better quality of life.

“I couldn’t recommend Dr. Myers highly enough,” concludes Kathleen. “I love Milford Regional; also, the nurses on the day of the surgery were fantastic. The only thing I regret about this surgery is that I didn’t do it sooner. If you’re considering it, just do it. You’ll be glad you did.”

Learn more about Mary Kay Myers, MD or call Women's Health of Franklin for an appointment at 774-462-3910.