By Yolanda Heiberger

In early 2006, 30-year-old Sarah Thomas was facing the need for a radical hysterectomy as treatment for early-stage cervical cancer. But as a physically active, busy working mother of two young boys, Sarah was understandably concerned about how the recuperation time after surgery might limit her ability to care for her family and return to work. “Our family leads a full, active life, so being able to get back to my normal routine quickly was a priority for me,” Sarah recalls. Fortunately, due to a revolutionary surgical technique she received at UAB, Sarah was able to resume most of her routine activities and return to work within two weeks after her hysterectomy. Instead of undergoing a traditional, open surgery requiring a large abdominal incision, Sarah received a minimally invasive, robot-assisted hysterectomy using the da Vinci® surgical system. “The da Vinci procedure—an advanced form of laparoscopic surgery—has proven to be a superior alternative to the traditional hysterectomy, resulting in less bleeding, pain and scarring,” explains UAB gynecologic oncologist Warner K. Huh, M.D., who performed Sarah’s surgery in June 2006. “One of the primary benefits to our patients receiving robot-assisted surgery is that the recovery time is reduced from two months for a traditional open surgery to around two weeks for a da Vinci procedure,” Dr. Huh adds.

In 2006, UAB was the first hospital in Alabama to use its da Vinci surgical system, acquired in 2001, in cancer-related gynecologic surgeries. Dr. Huh says that today, the da Vinci robot has opened significant windows of opportunity for a wide range of patients who require gynecologic surgery for the treatment of cancer as well as benign conditions. “Robot-assisted surgery provides a low-risk, minimally invasive option to nearly all gynecologic patients requiring hysterectomies and other types of pelvic surgeries,” Dr. Huh says. In this ehealth interview, Sarah describes her experience as one of the first patients in Alabama to undergo a radical hysterectomy with the assistance of the da Vinci surgical system. Dr. Huh explains how the intricately designed da Vinci surgical robot provides significant benefits to the surgeon, resulting in a more precise, lower risk procedure in comparison to a traditional open surgery. Also, Dr. Huh provides insight into the future of robot-assisted surgery and the ways in which this revolutionary technology is transforming the surgical experience for physicians and patients alike.

Sarah: “I was referred to Dr. Huh by my gynecologist in early 2006, after a routine Pap smear and a biopsy indicated that I had cervical cancer. I was surprised by the news, but my first concern was to seek the best treatment possible. Dr. Huh at UAB was highly recommended.”

Dr. Huh: “When Sarah came to me, we performed a surgical procedure called a cone biopsy to confirm the diagnosis and extent of her cancer. She had early invasive cervical cancer, which has a high cure rate when found and treated at this early stage. The standard recommended treatment is a radical hysterectomy, in which the uterus and cervix are surgically removed. Because of Sarah’s young age, I advised that her ovaries be left intact since cervical cancer does not typically spread to the ovaries.”

Sarah: “As a wife, mother of two young boys, and a buyer for an industrial fabrication company, I have a busy life. Also, I exercise and train regularly in a variety of high-intensity cardiovascular activities; in fact, I was in the middle of a fitness challenge when I was diagnosed. Without compromising my treatment, being able to return to my normal routine as quickly as possible after my hysterectomy was a major concern for me.”

Dr. Huh: “In learning that Sarah has two young children and leads such an active life, I offered her the option of receiving a da Vinci surgical procedure. This is an advanced laparoscopic technique performed with the aid of a surgical robot that is completely controlled and manipulated by the surgeon. At that time, only a few hospitals in the nation were using the technology for gynecologic surgery. UAB was the first hospital in Alabama to apply the technology in this way.”

Instead of the large abdominal incision required in a conventional, open hysterectomy, the da Vinci robot allows the surgeon to operate through small punctures in the abdomen. The surgeon operates while seated at a console, a few feet away from the patient, and looking through a viewfinder. Because the viewfinder projects a unique, 3-D image not available in traditional laparoscopic surgery, the surgeon is afforded greater precision and accuracy with this method. The surgeon’s hands are naturally positioned on the controls below the display during the operation, and movements are transferred real-time to the surgical instruments inside the patient. The da Vinci robot is under the complete control of the surgeon at all times and cannot be programmed to make decisions or move independently in any way.

Sarah: “Dr. Huh was very thorough in explaining how the procedure is performed, and he also gave me literature about the technique so that I could make an informed decision. My husband and I did a good deal of research on the Internet as well, not only about the da Vinci procedure but also about radical hysterectomy. At that time, doing research also helped me deal with my diagnosis because I felt as though I had some control.

“Based on my research and conversations with Dr. Huh, I became convinced that the da Vinci procedure was the best surgical option for me—certainly better than an open hysterectomy. My husband had some concerns initially, but Dr. Huh was very thorough in addressing each one and making us both feel comfortable. The ability to get back to my life quickly was a major factor in my decision to undergo the da Vinci procedure.”

Dr. Huh: “As a surgeon, you want to perform the procedure that is right for the patient, and this is the central theme of our care at UAB. I explained to Sarah that, in her individual case, we could actually perform her surgery using the da Vinci technique. I explained to her that the potential benefits would include a faster recovery without compromising the surgical goals.

“Sarah underwent the da Vinci hysterectomy in June 2006, and she was one of the first patients at UAB to receive a radical hysterectomy using the robot. Her surgery went phenomenally well. I believe she was in the hospital just over a day, right Sarah?”

Sarah: “Yes. My surgery was at 8 a.m., and I was home by lunchtime the following day. When I first woke up after the surgery, I did have some mild discomfort. But, the pain was very manageable. By that evening, I was already taking walks down the hallway in the hospital.”

Dr. Huh: “A significant advantage of this procedure, unlike conventional open surgery, is that patients require minimal narcotic pain medication, if any. These medications can often prolong a patient’s recovery due to side effects such as profound drowsiness. Without narcotics, patients are able to return home and resume normal activities much more quickly after their surgery.”

Sarah: “Within one week, I was already working from home. My main limitation during the first week was due more to the fact that I came home with a catheter.”

Dr. Huh: “Yes, most patients return home with a catheter because they can’t urinate normally for the first few days because of the way the surgery is conducted. Sarah had the catheter about six days, which is the typical length of time most patients require it.”

Sarah: “Because I received instructions at the hospital ahead of time, I was able to remove the catheter myself at home without having to return to the hospital. Everything went fine, and I had no problems. Once the catheter was removed, I was able to do most of my routine activities. By two weeks after surgery, I was back in the office working almost full days. Also at this point, I was able to begin swimming again, which was great.”

Dr. Huh: “To fully appreciate the recovery Sarah experienced, you have to compare it to the recovery time with a conventional hysterectomy. Typically, a patient who undergoes an open hysterectomy remains in the hospital three or four days and doesn’t resume normal activity for at least four to five weeks. So the da Vinci surgery cuts this recovery time in half, roughly.

“The procedure also provides the surgeon several advantages that make it superior to an open hysterectomy. First, the technique allows for improved visualization, providing a clear 3-D image and the feel of a traditional operation. Blood vessels are more easily identified, and blood loss during the procedure is drastically minimized. Reduced blood loss is a major factor in patients’ accelerated recovery time after a da Vinci procedure.

“Another surgical advantage is that the instruments used during a da Vinci procedure allow for much greater dexterity and flexibility than the instruments used in standard laparoscopy; I’m able to manipulate my instruments in a manner that is impossible with standard laparoscopy. Also, the robot allows us to operate in a much smaller, tightly focused space—roughly the size of plum. This is about one-third of the standard surgical space of an open hysterectomy, and the reduced surgical field minimizes injury to surrounding tissue and blood vessels. All of these advantages are cumulative, resulting in a faster recovery for the patient and an improved surgery compared to conventional open hysterectomy and standard laparoscopy.”

Sarah: “For me, the da Vinci procedure was definitely the right choice. I received the surgery I needed and was able to get back to my normal routine very quickly. I’m grateful the option was available to me.”

Dr. Huh: “Fortunately, the pathology report we received after Sarah’s surgery showed that the cancer hadn’t spread beyond the cervix, so she required no further treatment. Sarah is a great example of the recovery patients can achieve with robot-assisted surgery. Because of this advancement, we now have the opportunity to offer nearly all women who need gynecologic surgery the option of laparoscopic surgery performed with the da Vinci robot. It’s remarkable to think that many of my senior partners come from an era when their radical hysterectomy patients remained in the hospital for seven to 10 days. Now, we have patients who leave in less than 24 hours—but we haven’t sacrificed the primary goals of their surgery. Patients actually receive a comparable if not better surgery with fewer complications and a faster recovery.”

For more information about the Gynecologic Oncology Clinic at UAB Highlands, visit uabhealth.org/gynonc. Call the UAB Cancer Answers phone line at (205) 975-8222 or 1-800-UAB-0933 for appointments or more information about clinic services. 

Find out more about the da Vinci^® hysterectomy by visiting uabhealth.org/davincihysterectomy.

To learn more about cervical cancer, visit uabhealth.org/cervicalcancer.

For a copy of UAB’s gynecologic oncology brochure, call (205) 996-6000.