Complex gynaecological procedures can be performed with much greater precision and with less damage to neighbouring tissues than with standard techniques. This ensures optimum treatment outcomes for our patients.

Non-cancerous conditions

Hysterectomy for non-cancerous gynaecological conditions

We are able to offer patients with very large wombs either complete removal of the womb (total hysterectomy) or removal of the main body of the womb, but not the cervix (supracervical hysterectomy). Robot-assisted techniques can also be used for procedures such as removing fibroids (non-cancerous muscle lesions) or treating endometriosis (a non-cancerous condition affecting the lining of the womb). As a result many patients are able to avoid having to have an abdominal incision.

The most common procedure for treating gynaecological conditions such as heavy periods, fibroids, endometriosis and uterine prolapse is hysterectomy (removal of the womb). Statistically, one in three women in Europe and the US will undergo a hysterectomy before the age of 60. Although this figure is lower in other countries, hysterectomy is nonetheless one of the most common gynaecological procedures worldwide.

Today, many women choose minimally invasive surgery in order to avoid the large abdominal incision, recovery from which takes 4–6 weeks, associated with traditional open hysterectomy. Conventional laparoscopy is also minimally invasive, but the rigid, long-handled instruments used can prove problematic when carrying out complex, difficult operations.

We offer two types of hysterectomy using the da Vinci® system:

  • Total laparoscopic hysterectomy (TLH):
    The womb and cervix are removed using da Vinci® instruments via 3–5 small incisions in the abdominal wall.
  • Laparoscopic supracervical hysterectomy (LSH):
    The womb is removed using da Vinci® instruments via 3–5 small incisions in the abdominal wall. The cervix is left in place. The womb is removed via a small incision using a morcellator.

Fibroid removal (myomectomy)

A new type of minimally invasive myomectomy, the da Vinci® myomectomy, combines the benefits of open and laparoscopic surgery. Using the da Vinci® surgical system, uterine fibroids can be removed via small incisions with unmatched precision and control. One of the advantages of da Vinci myomectomy over traditional open abdominal surgery is the much lower complication risk. Blood loss is also minimised and patients recover much more quickly from the operation.

Robot-assisted myomectomy is performed using the da Vinci® surgical system, which enables the surgeon, irrespective of the size and position of the fibroids, to perform a minimally invasive, but nevertheless remarkably precise, extensive repair to the wall of the womb. The da Vinci® system offers a unique degree of controllability, facilitating extremely precise and meticulous repair of the wall of the womb and helping prevent tearing of the uterus in the event of future pregnancy. Thanks to the highly sensitive da Vinci® technique, you should still be able to have children even after such a major procedure.


Surgery for uterine or vaginal vault prolapse (sacrocolpopexy)

Many women have to undergo surgery for uterine (womb) or vaginal vault prolapse. Pelvic organ (vagina, womb, bladder or rectum) prolapse occurs when the connective tissue or muscles of the body cavity have diminished in strength and are unable to hold the pelvis in its natural position.

Connective tissue can be weakened by advancing age, after having a baby, following weight gain or through hard physical work. Women with a prolapse of the pelvic organs sometimes suffer from urinary incontinence, vaginal ulceration, disorders of sexual function or difficulty emptying their bowels.

What are the different types of pelvic floor weakness?

Prolapse

In a prolapse, an organ has moved out of its original anatomical position and is bulging towards the vagina. The type of pelvic floor weakness depends on the organ which has prolapsed – prolapse of more than one organ is not uncommon.

Deszensus (= Senkung)

Anterior prolapse (cystocoele)

In anterior prolapse, the bladder bulges into the vagina. This occurs because the connective tissue in the anterior wall has failed to do its job. This is the most common type of prolapse.

Zystozele (Senkung der Blase)

Posterior wall prolapse (rectocoele)

In posterior wall prolapse, the rectum presses towards the vagina. This is also caused by a connective tissue weakness, in this case in the back wall of the vagina, allowing the lower bowel to bulge into the vagina.

Rektozele (Senkung des Mastdarms)

Prolapse of the top of the vagina (after total hysterectomy)

After a hysterectomy (removal of the womb), the bodily structures which previously held the vagina in place are no longer there. This can cause the top of the vagina to press down towards the lower vagina.

Scheidenstumpfprolaps (Senkung des Scheidenstumpfes nach einer Totaloperation)

Uterine prolapse

Even in women who still have their uterus (womb), the structures supporting the uterus can be impaired, causing the uterus to push downwards.

Uterusprolaps (Senkung der Gebärmutter)

Source for figures: www.bard.de

A sacrocolpopexy involves fixing the vaginal vault prolapse using a mesh, which holds the vagina in the correct anatomical position. This procedure can also be performed to provide long-term support for the vagina following hysterectomy for a uterine prolapse.

Sacrocolpopexy is traditionally performed using open surgery. This involves making a 15–30 cm incision in the lower abdomen to provide access to abdominal organs such as the womb.

If you doctor advises you to have a sacrocolpopexy, you may be able to benefit from a new surgical procedure – the da Vinci® sacrocolpopexy. This procedure involves using a state-of-the-art surgical system which allows the surgeon to use a minimally invasive technique via a number of small incisions.

For most women, the da Vinci® sacrocolpopexy offers numerous advantages over traditional open surgical techniques, including:

  • significantly less pain
  • less blood loss, fewer transfusions
  • lower infection risk
  • less scarring
  • shorter hospital stay
  • faster recovery
  • faster resumption of normal activities