Description

The advent of robotic-assisted surgery has transformed the field of gynecology by offering enhanced precision, superior visualization, and improved ergonomics for surgeons. Among the most commonly performed robotic gynecologic procedures are hysterectomy and myomectomy, both of which benefit significantly from robotic technology. For gynecologists seeking to adopt or refine these techniques, a structured, step-by-step approach is essential to ensure safety, efficiency, and optimal patient outcomes. The process begins with careful patient selection and preoperative evaluation. Indications for robotic hysterectomy include benign conditions such as fibroids, adenomyosis, and abnormal uterine bleeding, as well as selected malignant cases. Robotic myomectomy is particularly advantageous for large, multiple, or deeply located fibroids where precision suturing is critical. Preoperative imaging, thorough counseling, and informed consent play a vital role in planning the procedure. Patient positioning and port placement form the foundation of a successful robotic surgery. The patient is placed in a low lithotomy position with steep Trendelenburg to allow adequate pelvic exposure. Proper port mapping ensures optimal instrument reach and prevents external and internal arm collisions. Once docking of the robotic system is completed, the surgeon gains a stable three-dimensional, high-definition view of the operative field. In robotic hysterectomy, the step-by-step approach involves systematic dissection of the pelvic structures. This includes coagulation and division of the round ligaments, development of the vesicouterine space, secure sealing of uterine vessels, and careful separation of the uterus from surrounding tissues. The robotic platform allows meticulous dissection near vital structures such as the ureters and bladder, reducing the risk of injury. Specimen removal and vaginal cuff closure are performed with excellent suturing control, which is a key advantage of robotic assistance. Robotic myomectomy follows a similarly structured sequence. After identifying the fibroids, vasopressin may be injected to minimize blood loss. Precise serosal incision and enucleation of fibroids are achieved using wristed robotic instruments. The ability to perform multilayer uterine suturing with accuracy is one of the greatest strengths of robotic surgery, contributing to strong uterine reconstruction and improved fertility outcomes. Morcellation or contained extraction techniques are then used for specimen removal. Postoperative care focuses on early mobilization, pain control, and rapid recovery. Robotic hysterectomy and myomectomy are associated with less blood loss, reduced postoperative pain, shorter hospital stays, and faster return to daily activities compared to open surgery. In conclusion, robotic hysterectomy and myomectomy represent a significant advancement in minimally invasive gynecologic surgery. A step-by-step, standardized approach enables gynecologists to harness the full potential of robotic systems while maintaining high standards of safety and surgical excellence. With appropriate training and experience, robotic surgery can greatly enhance both surgeon performance and patient satisfaction.