Northwestern MedicineRobotic-assisted Total Laparoscopic Hysterectomy

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A robotic-assisted total laparoscopic hysterectomy demonstrates the strategic advantages of robotic technology in managing complex gynecologic cases with previous surgical history. Dr. Susan C. Tsai of Northwestern Medicine details the procedure performed on a 44-year-old patient with persistent heavy bleeding following a failed endometrial ablation, complicated by adhesions from two prior C-sections and a posterior uterine fibroid weighing 274 grams.

Key Points:

• The case highlights specific advantages of robotic assistance, particularly the enhanced 3D visualization critical for identifying and managing adhesions from previous C-sections
• Prior failed endometrial ablation potentially resulted in retrograde menstruation, evidenced by blood collection near the fallopian tubes – suggesting incomplete ablation of the uterine lining
• The procedure required careful management of significant abdominal adhesions, with the uterus adherent to the anterior abdominal wall requiring meticulous dissection
• The surgical approach included contained morcellation technique (C-technique) to remove larger specimens through smaller incisions, resulting in approximately 3 cm final incision size
• The case emphasizes the critical role of proper uterine manipulation during the procedure, with the assistant’s positioning significantly influencing surgical exposure and access

“I always tell patients it’s like peeling a sticker off a peel pack; it should be really nice and easy. Hers was not, so evidence of somebody’s been there—in her case, two C-sections—which caused it to be much stickier than normal.”
– Susan Tsai, MD, Associate Professor, Obstetrics and Gynecology

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