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Minimally Invasive Procedures / Surgery

One in three women in the U.S. will have a hysterectomy before she turns 60. While no woman wants to face surgery, today the vast majority of gynecologic conditions - from endometriosis to uterine fibroids, heavy menstrual bleeding to cancer - can now be treated effectively without a big incision. With da Vinci® Surgery, a hysterectomy requires only a few small incisions, so you can get back to life faster - within days rather than the usual weeks required with traditional surgery.

Da Vinci Surgery

da Vinci Surgery enables gynecologists to perform the most precise, minimally invasive hysterectomy available today. For most women, da Vinci Hysterectomy offers numerous potential benefits over traditional open surgery, including:

    • Significantly less pain
    • Minimal blood loss and need for transfusion
    • Fewer complications
    • Shorter hospital stay
    • Quicker recovery and return to normal activities
    • Better outcomes and patient satisfaction, in many cases

Surpassing the limits of conventional laparoscopic surgery, da Vinci is revolutionizing gynecologic surgery for women. No wonder more and more women are choosing da Vinci Surgery for their hysterectomy. In fact, since it was cleared by the FDA in 2005, surgeons have performed more than 100,000 da Vinci Hysterectomies.

If you have been putting off surgery to resolve a gynecologic problem, it's time to ask your doctor about da Vinci Surgery.

da Vinci Patient Testimonials

"Dr. Santiago and staff, I can't say enough about how great the da Vinci hysterectomy went. The recovery time was so much shorter just like you had told me. We had been discussing the possibility of a hysterectomy for some time but honestly I was hesitant on having it done because of the time off that I would need to have. Thank you so much for having this as an option. I will recommend it to everyone I know!"

- da Vinci robotic hysterectomy patient

Endometriosis / Adenomyosis Removal

Endometriosis is a disease that affects your reproductive organs and monthly menstrual cycle. It can cause cramps and pain during your periods or pelvic pain throughout the month. If you have this disease and it is not treated, your health can be affected. But, with early diagnosis and treatment, endometriosis can be managed.
Understanding Endometriosis
If you have endometriosis, endometrial tissue grows outside the uterus in the pelvic cavity. During your menstrual cycle, this extra tissue swells with blood along with the normal tissue in your uterus. The tissue may also release tiny drops of blood. The swelling and blood irritate nearby tissues, causing pain and cramps. Constant irritation may cause scar tissue to form. This scar tissue can bind organs together and cause trouble getting pregnant (infertility).
endometriosis1
Common Symptoms
If you have endometriosis, you may have one or more of these symptoms:
  • Cramps and menstrual pain
  • Pelvic pain
  • Pain during sexual intercourse
  • Infertility. (Endometriosis is one of the most common causes of infertility.)
  • Abnormal or heavy menstrual bleeding.
Stages of endometriosis
The stages of endometriosis are ranked as follows: Minimal (I), Mild (II), Moderate (III), or Severe (IV). Staging depends on certain factors. These include the number, size, and site of the implants. The stage also depends on the extent of the adhesions and whether other pelvic organs are involved. The severity of your disease may not match the pain you feel. Even mild endometriosis can cause a lot of pain.
endometriosis2
Endometriosis can be treated with hormone therapy, surgery, or a combination of both. Talk to your health care provider to see which treatment is best for your condition
Hormone Therapy
Hormone therapy regulates or blocks the hormones that control your menstrual cycle. This means it can limit the swelling of your endometrium and extra endometrial tissue (implants). This treatment may be used before, instead of, or after surgery.
Surgery
Surgery can be used to remove implants of endometrial tissue or for removal of the reproductive organs.
  • With laparoscopy a laparoscope (a thin, lighted tube) is inserted through a small incision in your abdomen. Your doctor uses the laparoscope and another small instrument to remove the implants.
  • Surgical removal of the tissue may be required to relieve severe symptoms or to allow impregnation. Tissue may be destroyed by heat (electrocautery) or removed with lasers during laparoscopy (usually done on an outpatient basis under local anesthesia).
  • Laparotomy is open surgery to remove large implants that can't be reached with the laparoscope or when pelvic organs such as your bowel are involved.
  • Hysterectomy is the surgical removal of your uterus. Any implants or adhesions in your pelvic cavity will also be removed.
  • During a Total Hysterectomy with Bilateral Salpingo-Oophorectomy procedure, your uterus, ovaries, and fallopian tubes are removed. Any implants or adhesions in nearby tissue are also removed.
Surgical removal of the tissue or to have a hysterectomy can be done by the da Vinci system. Talk to Dr. Joe Santiago to see what is the best treatment for you.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

Fibroids & Treatment Options

Uterine fibroids* are benign (non-cancerous) tumors occurring in at least one quarter of all women. 1 They can grow underneath the uterine lining, inside the uterine wall, or outside the uterus.

Many women don't feel any symptoms with uterine tumors or fibroids. But for others, these fibroids can cause excessive menstrual bleeding (also called menorrhagia), abnormal periods, uterine bleeding, pain, discomfort, frequent urination and infertility.
Fibroids img 0
Treatments include uterine fibroid embolization — which shrinks the tumor — and surgery. Surgical treatment for uterine tumors most often involves the surgeon removing the entire uterus, via hysterectomy.

While hysterectomy is a proven way to resolve fibroids, it may not be the best surgical treatment for every woman. If, for example, you hope to later become pregnant, you may want to consider alternatives to hysterectomy like myomectomy. Myomectomy is a uterine-preserving procedure performed to remove uterine fibroids.
Types of Myomectomy
Each year, roughly 65,000 myomectomies are performed in the U.S. 4 The conventional approach to myomectomy is open surgery, through a large abdominal incision. 5 After cutting around and removing each uterine fibroid, the surgeon must carefully repair the uterine wall to minimize potential uterine bleeding, infection and scarring. Proper repair is also critical to reducing the risk of uterine rupture during future pregnancies. Menorrhagia is extensive menstrual bleeding.

While myomectomy is also performed laparoscopically, this approach can be challenging for the surgeon, and may compromise results compared to open surgery. 6 Laparoscopic myomectomies often take longer than open abdominal myomectomies, and up to 28% are converted during surgery to an open abdominal incision.
Fibroids img 1

A new category of minimally invasive myomectomy, da Vinci® Myomectomy, combines the best of open and laparoscopic surgery. With the assistance of the da Vinci Surgical System — the latest evolution in robotics technology — surgeons may remove uterine fibroids through small incisions with unmatched precision and control.
Learn more
If you would like to explore whether you are a candidate for myomectomy, ask your doctor.

* Uterine fibroids are also called fibroids, uterine tumors, leiomyomata (singular — leiomyoma) and myomas or myomata (singular — myoma)
  1. Newbold RR, DiAugustine RP, Risinger JI, Everitt JI, Walmer DK, Parrott EC, Dixon D. Advances in uterine leiomyoma research: conference overview, summary, and future research recommendations. Environ Health Perspect. 2000 Oct;108 Suppl 5:769-73. Review.
  2. National Institutes of Health: Fast Facts about Uterine Fibroids. www.nichd.nih.gov/publications/pubs/fibroids/sub1.htm#where
  3. Becker ER, Spalding J, DuChane J, Horowitz IR. Inpatient surgical treatment patterns for patients with uterine fibroids in the United States, 1998-2002. J Natl Med Assoc. 2005 Oct;97(10):1336-42.
  4. Lumsden MA.Embolization versus myomectomy versus hysterectomy: Which is best, when? Hum Reprod. 2002; 17:253-259. Review.
  5. Becker ER, Spalding J, DuChane J, Horowitz IR. Inpatient surgical treatment patterns for patients with uterine fibroids in the United States, 1998-2002. J Natl Med Assoc. 2005 Oct;97(10):1336-42.
  6. Kristen A. Wolanske, MD; Roy L. Gordon, MD. Uterine Artery Embolization: Where Does it Stand in the Management of Uterine Leiomyomas? Part 2. Appl Radiol 33(10):18-25, 2004. Medscape.10/27/2004.
  7. Advincula AP, Song A, Burke W, Reynolds RK. Preliminary experience with robot-assisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 2004 Nov;11(4):511
  8. While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.
While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

For additional information on minimally invasive surgery with the da Vinci® Surgical System visit www.davincisurgery.com

Types of Hysterectomy

Physicians perform hysterectomy — the surgical removal of the uterus — to treat a wide variety of uterine conditions. Each year in the U.S. alone, doctors perform approximately 600,000 hysterectomies, making it the second most common surgical procedure.
Hysterectomy img 0
Types of Hysterectomy
There are various types of hysterectomy that are performed depending on the patient's diagnosis:

Supracervical hysterectomy — removes the uterus, leaves cervix intact
Total hysterectomy — removes the uterus and cervix
Radical hysterectomy or modified radical hysterectomy — a more extensive surgery for gynecologic cancer that includes removing the uterus and cervix and may also remove part of the vagina, fallopian tubes, ovaries and lymph nodes in order to stage the cancer (determine how far it has spread).
Approaches to Hysterectomy
Surgeons perform the majority of hysterectomies using an "open" approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6-12 inch incision. When cancer is involved, the conventional treatment has always been open surgery using a large abdominal incision, in order to see and, if necessary, remove related structures like the cervix or the ovaries.

A second approach to hysterectomy, vaginal hysterectomy, involves removal of the uterus through the vagina, without any external incision or subsequent scarring. Surgeons most often use this minimally invasive approach if the patient's condition is benign (non-cancerous), when the uterus is normal size and the condition is limited to the uterus.

In laparoscopic hysterectomy, the uterus is removed either vaginally or through small incisions made in the abdomen. The surgeon can see the target anatomy on a standard 2D video monitor thanks to a miniaturized camera, inserted into the abdomen through the small incisions. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy alone.

While minimally invasive vaginal and laparoscopic hysterectomies offer obvious potential advantages to patients over open abdominal hysterectomy — including reduced risk for complications, a shorter hospitalization and faster recovery — there are inherent drawbacks. With vaginal hysterectomy, surgeons are challenged by a small working space and lack of view to the pelvic organs. Additional conditions can make the vaginal approach difficult, including when the patient has:
  • A narrow pubic arch (an area between the hip bones where they come together)
  • Thick adhesions due to prior pelvic surgery, such as C-section 3
  • Severe endometriosis 4
  • Non-localized cancer (cancer outside the uterus) requiring more extensive tissue removal, including lymph nodes
With laparoscopic hysterectomy, surgeons may be limited in their dexterity and by 2D visualization, potentially reducing the surgeon's precision and control when compared with traditional abdominal surgery.
da Vinci Hysterectomy
If your doctor recommends hysterectomy, you may be a candidate for da Vinci Hysterectomy, one of the most effective, least invasive treatment options for a range of uterine conditions. da Vinci Hysterectomy is performed using the da Vinci™ Surgical System, which enables surgeons to perform with unmatched precision and control — using only a few small incisions — da Vinci Hysterectomy.

Hysterectomy img 1

For most patients, da Vinci Hysterectomy can offer numerous potential benefits over traditional approaches to vaginal, laparoscopic or open abdominal hysterectomy, particularly when performing more challenging procedures like radical hysterectomy for gynecologic cancer. Potential benefits include:
  • Significantly less pain
  • Less blood loss
  • Fewer complications
  • Less scarring
  • A shorter hospital stay
  • A faster return to normal daily activities
Moreover, da Vinci provides the surgeon with a superior surgical tool for dissection and removal of lymph nodes during cancer operations, as compared to traditional open or minimally invasive approaches. 1 da Vinci Hysterectomy also allows your surgeon better visualization of anatomy, which is especially critical when working around delicate and confined structures like the bladder. This means that surgeons have a distinct advantage when performing a complex, radical hysterectomy involving adhesions from prior pelvic surgery or non-localized cancer, or an abdominal hysterectomy. 2

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient-and procedure-specific. While radical hysterectomy or abdominal hysterectomy performed using the da Vinci Surgical System are considered safe and effective, these procedures may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.
Learn More
If you are a candidate for hysterectomy, talk to a gynecologist or gynecologic oncologist (a cancer specialist) who performs da Vinci Hysterectomy.
  1. Boggess JF. da Vinci® Hysterectomy for Endometrial Cancer with Staging. Presented at ISI WWSSM 1/06. 871391_rev B_dVH Endometrial Cancer Presentation
  2. UNC Department of Obstetric & Gynecology Health & Healing in the Triangle Vol 8 No 3 pp 22-23.
While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with theda Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

For additional information on minimally invasive surgery with the da Vinci® Surgical System visit www.davincisurgery.com

Uterine or Vaginal Prolapse

U.S., pelvic support defects are relatively common and increase with age. More than 120,000 women have surgery for uterine and vaginal vault prolapse each year in the United States. One study of more than 16,000 patients found the rate of uterine prolapse to be 14.2%. The mean age at time of surgery for pelvic organ prolapse was 54.6 years.

Uterine prolapse ("dropped uterus") is a condition in which a woman's uterus (womb) sags or slips out of its normal position. The uterus may slip enough that it drops partially into the vagina (the birth canal), creating a perceptible lump or bulge. This is called incomplete prolapse. In a more severe case—known as complete prolapse—the uterus slips to such a degree that some of the tissue drops outside of the vagina.
pimage002\
Prolapse literally means "to fall out of place." In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is generally reserved for organs protruding through the vagina, or for the misalignment of the valves of the heart.
Causes of Uterine Prolapse
Trauma incurred during the birthing process, particularly with large babies or after a difficult labor and delivery, is one of the main causes of the muscle weakness that leads to uterine prolapse. Reduced muscle tone from aging, as well as lowered amounts of circulating estrogen after menopause, may also form contributing factors in pelvic organ prolapses. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.

Genetics also may play a role; women of Northern European descent experience a higher incidence of uterine prolapse than do women of Asian and African heritage. 2

Finally, increased intra-abdominal pressure, stemming from such diverse conditions as obesity, chronic lung disease and asthma, can be contributing factors in uterine prolapse. 3
Surgical Options
Hysterectomy
Uterine prolapse may be treated by removing the uterus in a surgical procedure called hysterectomy. This may be done through an incision made in the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy). Hysterectomy is major surgery, and removing the uterus means pregnancy is no longer possible.
da Vinci® Sacrocolpopexy: : Surgery for Uterine or Vaginal Vault Prolapse
Sacrocolpopexy is a procedure to surgically correct vaginal vault prolapse where mesh is used to hold the vagina in the correct anatomical position. This procedure can also be performed following a hysterectomy to treat uterine prolapse to provide long-term support of the vagina. Robotically-assisted laparoscopic surgery is an effective alternative to traditional surgery for treatment of vaginal vault prolapse, U.S. researchers report. Robotic surgery involves the use of the da Vinci® Surgical System that helps speedup the repair and simplifies technically difficult aspects of vaginal vault prolapse surgery. A recent Mayo Clinic study of 30 women who had robot-assisted laparoscopic repair concluded that this method has the following advantages over traditional open surgical repair.

Sacrocolpopexy has traditionally been performed as an open surgery. A 15-30 cm horizontal incision is made in the lower abdomen in order to manually access the inter-abdominal organs, including the uterus.
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If your doctor recommends sacrocolpopexy, you may be a candidate for a new surgical procedure called da Vinci Sacrocolpopexy. This procedure uses a state-of-the-art surgical system designed to help your surgeon perform a minimally invasive surgery through small incisions.

For most women, da Vinci Sacrocolpopexy offers numerous potential benefits over a traditional open approach:
  • Significantly less pain
  • Less blood loss and need for transfusions
  • Less risk of infection
  • Less scarring
  • Shorter hospital stay
  • Shorter recovery time
  • Quicker return to normal activities
As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient- and procedure.
  1. "Robot Technology Improves Vaginal prolapse Surgery," U.S. Dept. of Health & Human Services, healthfinder.gov. URL: http://www.healthfinder.gov/news/newsstory.asp?docID=534003 
  2. "Women's Health: Uterine prolapse," MayoClinic.com. URL: http://www.mayoclinic.com/health/uterine-prolapse/DS00700/DSECTION=3
  3. "Uterine Prolapse," eMedicine from WebMD. www.emedicine.com. URL: http://www.emedicine.com/emerg/topic629.htm
  4. "Uterine Prolapse," eMedicine from WebMD. www.emedicine.com. URL: http://www.emedicine.com/emerg/topic629.htm 
While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

Frequently Asked Questions about da Vinci Surgery

Q. What is Minimally Invasive Surgery (MIS)?
A. MIS is surgery typically performed through small incisions, or operating ports, rather than large incisions, resulting in potentially shorter recovery times, fewer complications, reduced hospitalization costs and reduced trauma to the patient. While MIS has become standard-of-care for particular surgical procedures, it has not been widely adopted for more complex or delicate procedures — for example, prostatectomy and mitral valve repair.

Intuitive Surgical believes that surgeons have been slow to adopt MIS for complex procedures because they generally find that fine-tissue manipulation — such as dissecting and suturing — is more difficult than in open surgery. Intuitive Surgical's technology, however, enables the use of MIS techniques for complex procedures.

Q. Why do we need a new way to do minimally invasive surgery?
A. Despite the widespread use of minimally invasive or laparoscopic surgery in today's hospitals, adoption of laparoscopic techniques, for the most part, has been limited to a few routine procedures. This is due mostly to the limited capabilities of traditional laparoscopic technology, including standard video and rigid instruments, which surgeons must rely on to operate through small incisions.

In traditional open surgery, the physician makes a long incision and then widens it to access the anatomy. In traditional minimally invasive surgery â€" which is widely used for routine procedures -- the surgeon operates using rigid, hand-operated instruments, which are passed through small incisions and views the anatomy on a standard video monitor. Neither this laparoscopic instrumentation nor the video monitor can provide the surgeon with the excellent visualization needed to perform complex surgery like valve repair or nerve-sparing prostatectomy.

Q. What are the benefits of da Vinci Surgery compared with traditional methods of surgery?
A. Some of the major benefits experienced by surgeons using the da Vinci Surgical System over traditional approaches have been greater surgical precision, increased range of motion, improved dexterity, enhanced visualization and improved access. Benefits experienced by patients may include a shorter hospital stay, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities. None of these benefits can be guaranteed, as surgery is necessarily both patient- and procedure-specific.

Q: Where is the da Vinci Surgical System being used now?
A. Currently, The da Vinci Surgical System is being used in hundreds of locations worldwide, in major centers in the United States, Austria, Belgium, Canada, Denmark, France, Germany, Italy, India, Japan, the Netherlands, Romania, Saudi Arabia, Singapore, Sweden, Switzerland, United Kingdom, Australia and Turkey.

Q. Has the da Vinci Surgical System been cleared by the FDA?
A.The U.S. Food and Drug Administration (FDA) has cleared the da Vinci Surgical System for a wide range of procedures. Please see the FDA Clearance page for specific clearances and representative uses.

Q: Is da Vinci Surgery covered by insurance?
A. da Vinci Surgery is categorized as robot-assisted minimally invasive surgery, so any insurance that covers minimally invasive surgery generally covers da Vinci Surgery. This is true for widely held insurance plans like Medicare. It is important to note that your coverage will depend on your plan and benefits package. For specifics regarding reimbursement for da Vinci Surgery, or if you have been denied coverage, please call the Reimbursement Hotline at 1-888-868-4647 ext. 3128. From outside the United States, please call 33-1-39-04-26-90.

Q. Will the da Vinci Surgical System make the surgeon unnecessary?
A. On the contrary, the da Vinci System enables surgeons to be more precise, advancing their technique and enhancing their capability in performing complex minimally invasive surgery. The System replicates the surgeon's movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical maneuver without the surgeon's input.

Q. Is a surgeon using the da Vinci Surgical System operating in "virtual reality"?
A. Although seated at a console a few feet away from the patient, the surgeon views an actual image of the surgical field while operating in real-time, through tiny incisions, using miniaturized, wristed instruments. At no time does the surgeon see a virtual image or program/command the system to perform any maneuver on its own/outside of the surgeon's direct, real-time control.

Q. Is this telesurgery? Can you operate over long distances?
A. The da Vinci Surgical System can theoretically be used to operate over long distances. This capability, however, is not the primary focus of the company and thus is not available with the current da Vinci Surgical System.

Q. While using the da Vinci Surgical System, can the surgeon feel anything inside the patient's chest or abdomen?
A. The system relays some force feedback sensations from the operative field back to the surgeon throughout the procedure. This force feedback provides a substitute for tactile sensation and is augmented by the enhanced vision provided by the high-resolution 3D view.

Q: What procedures have been performed using the da Vinci Surgical System? What additional procedures are possible?
A. The da Vinci System is a robotic surgical platform designed to enable complex procedures of all types to be performed through 1-2 cm incisions or operating "ports." To date, tens of thousands of procedures including general, urologic, gynecologic, thoracoscopic, and thoracoscopically-assisted cardiotomy, transoral surgery, thyroid procedures have been performed using the da Vinci Surgical System.

Q. Why is it called the da Vinci® Surgical System?
A. The product is called "da Vinci" in part because Leonardo da Vinci invented the first robot. He also used unparalleled anatomical accuracy and three-dimensional details to bring his masterpieces to life. The da Vinci Surgical System similarly provides physicians with such enhanced detail and precision that the System can simulate an open surgical environment while allowing operation through tiny incisions.

For more information please visit www.davincisurgery.com

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

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