Robotic Hysterectomy
A Return to Normal
Before her hysterectomy at Milford Regional, Holly Collette says that her life revolved around her periods. She coped with severe menstrual pain and heavy bleeding that affected her at work, made vacations and outings difficult to schedule, and eventually bothered her on a daily basis.
“I’ve passed out at least a half dozen times, and sometimes I would shake uncontrollably,” notes Holly, 46. “Vacations would get ruined, and it was hard trying to go to work when it hurt. It impacts a lot.”
Since her robotic hysterectomy on Dec. 15, 2017, everything has changed. Holly has her life back, and to her surprise, it didn’t take long. While an open procedure would have kept her homebound for several weeks, she attended a gathering a mere two days after her surgery. Holly was back to working full-time in three weeks. “My periods were so painful compared to my recovery,” says Holly. “I only took Advil twice a day for a couple days after the surgery. The next morning I was up and dressed and walking around; it wasn’t bad.”
Brian Clark, MD, FACOG of New England Reproductive Medicine and Surgery in Millbury, the surgeon who performed the procedure, says that hysterectomies have come a long way over the past couple decades and that the robotic element adds many advantages.
“It’s less risk, less pain and a much faster route to getting back to their normal lives,” explains Dr. Clark. “With the robot, there are 3-5 incisions, typically 8 mm, scattered through the abdomen. They’re so small that you could actually leave the incisions alone and let them heal on their own. We don’t do that, we close them, but you could. You can never ignore a big incision, and with open surgery, you have a 10-15 centimeter incision. Twenty years ago when I first started performing hysterectomies, women would recover at home for four to six weeks before coming to my office to discuss their return to work. Now they’re coming to see me in two weeks. They’re not back to work yet, but they’re recovering and there is a huge difference in how they feel.”
According to Dr. Clark, 80 percent of patients go home the day of surgery, and if they stay the night, it’s most likely because they were scheduled late in the day. “The length of stay is one of the beautiful things about this,” he says. “They’re not going to be going fast or doing much initially, but I expect them to improve readily. Two days later, they should be able to see they’re getting better, and it will keep improving.”
Robotic surgery also has many benefits for the physician performing the procedure such as improved visualization, access, and internal movement. In Holly’s case, it helped him to see more of her severe endometriosis, a condition where tissue similar to the lining of the uterus is found elsewhere in the body, so that he could treat it more aggressively. Endometriosis can cause scar tissue and adhesions to develop that can distort a woman’s internal anatomy. Holly had it everywhere, including around her appendix and an ovary.
“It’s a very enigmatic disease,” acknowledges Dr. Clark. “It seems to run in families to some degree, and it can occur by different mechanisms. There's no one answer as to how you get it, what it looks like, and how severe it is. You can use any energy source you want to destroy it. If it’s not very serious, you might just cauterize it. You can also use excisions or lasers to ablate it.”
Because her organs were impacted, Holly needed to have both her appendix and one ovary removed. Dr. Clark usually tries to save at least one ovary so his patient won’t go into early menopause. He explains that all hysterectomy patients, whether they have endometriosis or not, will need to weigh the pros and cons of keeping their ovaries. With endometriosis, it can be a particularly difficult decision as the disease can eventually recur. “With fibroids, it’s not the same risk of recurrence,” states Dr. Clark. “With endometriosis, you have a debate of recurrence versus early menopause which can lead to other problems. If someone is showing signs of being close to menopause, you’re not changing much by removing them, but if it’s someone who is thirty, that’s a huge difference as menopause affects things like bone health, breast health, colon health, and cognitive function. It’s not an easy decision and there is no perfect answer.”
He notes that only about five percent of patients who have menstrual problems will need a major surgical intervention. Depending on the issue, possible options could include prescribing oral contraceptives; removing polyps; inserting a Mirena hormonal intrauterine device; undergoing a myomectomy to take out symptom-causing fibroids and reconstruct the uterus; going into the abdomen to treat endometriosis without removing anything; or endometrial ablation, which burns the lining of the uterus to prevent re-growth of the tissue (not recommended for women who want to bear a child someday). “You consider all the options for every patient and mold the choices based on her point of view and her goal for her reproductive system,” he says. “If you have a younger woman, she may want to save her reproductive system. Some of these problems can be recurring and eventually get to the point where they need a hysterectomy. When they were twenty-eight, that might not have been an option as they wanted to have a child, but when they’re forty-eight, it’s not an issue anymore.”
Holly has dealt with menstrual problems since her late teens and has a family history of period issues. Over the years she had tried everything including prescriptions, D&C procedures to remove tissue from inside the uterus and to check for cancers and precancerous changes, ablation, and having part of her cervix removed. The various treatments offered a Band-Aid fix, helping for a little while, but gradually the problems escalated. “It would slowly get worse and worse,” Holly says. “Finally the last straw was in 2017 when I was bleeding for almost a year straight.”
Holly, who lives in Spencer, was referred to Dr. Clark that August and says they discussed how to do the least amount of procedures and fix the most problems. “Dr. Clark is amazing,” she says. “He tells you like it is and is to the point. He makes sure you understand. I can’t say enough good things about Dr. Clark and his staff. Milford Regional was great too. It’s not as hectic as going into Worcester, parking is easy, and the nurses and staff were phenomenal. They answered every question and treated me like I was their only patient.”
Holly also appreciated how the anesthesiologists listened to her when she told them that in the past, she has come out of anesthesia feeling extremely sick. This time, she suffered no side effects. Over a year later, Holly says the hysterectomy has made a huge difference in her life.
“I don’t have any issues now at all,” she marvels. “No more bleeding, no more pain, no more PMS. Once I healed up, I felt like I had a normal life. I can go places and do things and don’t have to plan it around a period.”
Read more about Brian Clark, MD or call 508-917-6720 to schedule an appointment with him.
