Robot-Assisted Laparoscopic Procedures

Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:

• Physical exam
• Blood tests
• Urine tests
• Electrocardiogram (ECG, EKG)—a test that records the electrical currents passing through the heart muscle
• Intravenous pyelogram (IVP)—a type of x-ray that creates images of the kidney, ureters, and bladder by injecting dye into the bloodstream
• Kidneys, ureter, bladder (KUB)—an x-ray of the abdomen
• Abdominal or pelvic ultrasound—a test that uses sound waves to visualize the inside of the body
• CT scan—a type of x-ray that uses a computer to create images of structures inside the abdomen or pelvis
• Dilation and curettage (D&C)—surgical removal of tissue from the lining of the uterus to diagnose or treat gynecologic or obstetric conditions

• Review your medications with the surgeon; you may need to stop taking some of them.
• Depending on the type of procedure, you may be asked to take a laxative and/or perform an enema to clean out your intestines.
• Follow a special diet, if recommended by your surgeon.
• Take antibiotics, if prescribed by your doctor.
• Shower the night before your procedure using antibacterial soap, if your doctor asks you.
• Arrange to have someone drive you to and from the hospital, and for help at home after your procedure.
• Eat a light meal the night before, and do not eat or drink anything after midnight unless told otherwise by your doctor.
• Plan to wear comfortable clothing on the day of your procedure.

Anesthesia

General or local anesthesia depending on the procedure

Description of the Procedure

The other two or three arms hold other instruments such as dissectors, scissors, scalpels, or forceps. These instruments are able to grasp, cut, dissect, and suture structures inside the abdomen during the operation.

While sitting at a console several feet away from the operating table, the surgeon looks through lenses at a magnified three-dimensional image of the inside of the abdomen and/or pelvis. Another surgeon stays by the patient during the procedure, where he can adjust the camera and instruments as needed.

With joystick-like hand controls and foot pedals, the surgeon at the console guides the movement of the robotic arms and surgical instruments. The robotic arms are able to perform surgical tasks with an increased range of motion than would be possible using traditional surgical techniques. In addition, the robotic arms can filter out hand tremor and translate the surgeon’s larger hand movements into smaller ones.

In procedures in which organs or tissues are removed, the organ or tissue is dropped into a specimen bag and removed through one of the openings.

After the endoscope and other instruments are removed, the surgeon closes the incisions with sutures or staples, and applies a sterile dressing.

After Procedure

If an organ or tissue was removed, it may be sent to a pathologist for examination.

How Long Will It Take?

Usually 1-2 hours, but this depends on the type of procedure being done.

Will It Hurt?

Anesthesia prevents pain during surgery. Patients typically experience pain, soreness, and or vaginal bleeding or discharge (in the case of gynecologic procedures) during recovery, but receive pain medication to relieve the discomfort. You may also feel bloated or have pain in your shoulder from the gas used during the procedure. This can last up to three days.

Possible Complications

General:

• Damage to neighboring organs or structures
• Infection
• Bleeding
• Anesthesia-related problems

Specific to cholecystectomy:

• Gallstones accidentally spill into the abdominal cavity

Specific to Nissen fundoplication:

• Difficulty swallowing, belching, or vomiting
• Narrowing of the esophagus requiring a subsequent procedure to dilate it

Specific to hysterectomy:

• Urinary incontinence
• Loss of ovarian function and early menopause
• Depression
• Sexual dysfunction

Specific to myomectomy:

• Recurrence of fibroids
• Perforation of the uterus or bowel during surgery
• Weakened uterine wall
• Pelvic adhesions that can cause pain or bowel obstruction
• Infertility
• Need for special precautions in pregnancy

Talk to your doctor about complications specific to the surgery you are having.

Also, sometimes it becomes necessary during the procedure to abandon the robotic method and perform the surgery using traditional methods (eg, traditional laparoscopic or open surgery).

Average Hospital Stay

Usually 1-2 days, but may be longer, depending on the procedure.

Postoperative Care

You will receive instructions on when and what you can eat, and how you need to restrict your activity. Depending on your procedure, your doctor will likely advise you to:

• Take antibiotics to help prevent infection.
• Avoid certain medications.
• Resume normal activities (eg, taking daily walks) soon, to promote healing.
• Gradually progress from a liquid to a solid diet.
• Eat a high-fiber diet, drink plenty of water, and use stool softeners if necessary to avoid constipation.
• Wash the incisions with mild soap and water.
• Limit certain activities, such as showering, bathing, driving, walking up stairs, lifting, working, and engaging in sexual intercourse, for a period of time.