Nathan Mordel, M.D. »Janet Lefkowitz, D.O. »

Robotically Assisted Laparoscopic Hysterectomy (RALH)

Medical Background

AJ, a woman in her middle thirties with three young children and her tubes tied after three C sections, had seen a significant decline in her quality of life due to painful and prolonged menstrual periods. Marked by a heavy flow, the concerning periods started two years ago and diminished her quality of life by keeping her away from work and under the influence of strong painkillers. After enduring the side effects of iron supplements to treat her ongoing anemia, she was diagnosed with large uterine fibroids by two OB/GYNs.

Following various unsuccessful treatments, AJ learned that she needed a hysterectomy but refused to have a blood transfusion and could not afford to commit to the hospital stay and the 6-8 week recovery period. When AJ presented at Atlanta Minimally Invasive Gynecological Surgery Center she was found to have a uterus that was “24 weeks” in size, roughly the size of a football, and weighed about 5 pounds as opposed to the standard uterus weight of 1-2 ounces.

Patient Results and Benefits of Minimally Invasive Robotically Assisted Laparoscopic Hysterectomy

Using a minimally invasive Robotically Assisted Laparoscopic Hysterectomy we were able to remove her uterus through 4 tiny incisions, each ¼ to ½ of an inch. There were no complications, no blood loss, and AJ was able to go home the same day and return to her normal life in just 2 weeks.

Proper recognition and understanding of surgical anatomy is paramount to successful and safe completion of any surgery, including RALH. Correct tissue handling and “prophylactic” hemostasis are equally important. These principles need to be followed regardless of the hysterectomy route. Employment of Robotic and/or Laparoscopic instrumentation can’t “miraculously” replace or even enhance these principles.

Location of ureters has to be known throughout the entire case. If needed, pelvic sidewall retroperitoneal dissection and sometimes ureterolysis are to be performed. Dissection of anterior and posterior leafs of the broad ligament need to be accomplished. Bladder flap has to be taken down to allow at least 1 centimeter width vaginal cuff. Skeletonization of ovarian (infundibulopelvic), uteroovarian and uterine vessels needs to be done in order to create at least 1 centimeter length pedicles. These pedicles have to be treated with bipolar energy and then transected achieving complete hemostasis. Vaginal cuff closure needs to be done with “generous bites” in two “running” layers using number 1 delayed absorption suture. Large uterus, usually more than 12-14 weeks (250-400 grams) size, has to be morcellated. 20 millimeter diameter blades greatly fascilitate morcellation.

Read Full Case Study (PDF)

View a video of a Robotically Assisted Laparoscopic Hysterectomy procedure

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