Hysterectomy with Bilateral Salpingo-Oophorectomy

  • Ernest S. HanEmail author
  • Stephen J. Lee


Hysterectomy is one of the most commonly performed gynecologic procedures. Historically, an abdominal, vaginal, or laparoscopic approach was utilized. With the advent of robotic technology, a new approach to hysterectomy is available to the surgeon. Although recent studies suggest that there are minimal differences in complications and outcomes between a laparoscopic approach compared to a robot-assisted laparoscopic approach, potential advantages of robotic surgery include its wristed instrumentation, three-dimensional immersive visualization, and increased surgical precision. This chapter discusses a robotic laparoscopic approach to hysterectomy with or without bilateral salpingo-oophorectomy. We will describe the technique and discuss issues that can arise during robotic surgery.


Hysterectomy Salpingo-oophorectomy Retroperitoneal 


  1. 1.
    ACOG Committee opinion no. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156–8.Google Scholar
  2. 2.
    Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database SystRev. 2015;8:CD003677. Scholar
  3. 3.
    Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, et al. Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg. 2010;252(2):254–62.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Albright BB, Witte T, Tofte AN, Chou J, Black JD, Desai VB, et al. Robotic versus laparoscopic hysterectomy for benign disease: a systematic review and meta-analysis of randomized trials. J Minim Invasive Gynecol. 2016;23(1):18–27.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Swenson CW, Kamdar NS, Harris JA, Uppal S, Campbell DA Jr, Morgan DM. Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications. Am J Obstet Gynecol. 2016;215(5):650.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Wright JD, Ananth CV, Lewin SN, Burke WM, Lu YS, Neugut AI, et al. Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA. 2013;309(7):689–98.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Mäenpää MM, Nieminen K, Tomás EI, Laurila M, Luukkaala TH, Mäenpää JU, Maenpaa MM, Nieminen K, Tomas EI, Laurila M, Luukkaala TH, Maenpaa JU. Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial. Ame J Obstet Gynecol. 2016;215(5):588.Google Scholar
  8. 8.
    Blecha S, Harth M, Schlachetzki F, Zeman F, Blecha C, Flora P, et al. Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45 degrees Trendelenburg position. BMC Anesthesiol. 2017;17(1):40.CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Hoshikawa Y, Tsutsumi N, Ohkoshi K, Serizawa S, Hamada M, Inagaki K, et al. The effect of steep Trendelenburg positioning on intraocular pressure and visual function during robotic-assisted radical prostatectomy. Br J Ophthalmol. 2014;98(3):305–8.CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Raman SR, Jamil Z. Well leg compartment syndrome after robotic prostatectomy: a word of caution. J Robot Surg. 2009;3(2):105–7.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Ulm MA, Fleming ND, Rallapali V, Munsell MF, Ramirez PT, Westin SN, et al. Position-related injury is uncommon in robotic gynecologic surgery. Gynecol Oncol. 2014;135(3):534–8.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    van den Haak L, Alleblas C, Nieboer TE, Rhemrev JP, Jansen FW. Efficacy and safety of uterine manipulators in laparoscopic surgery: a review. Arch Gynecol Obstet. 2015;292(5):1003–11.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Uccella S, Ghezzi F, Mariani A, Cromi A, Bogani G, Serati M, et al. Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature. Am J Obstet Gynecol. 2011;205(2):119.e1–12.CrossRefGoogle Scholar
  14. 14.
    Tsafrir Z, Palmer M, Dahlman M, Nawfal AK, Aoun J, Taylor A, et al. Long-term outcomes for different vaginal cuff closure techniques in robotic-assisted laparoscopic hysterectomy: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2017;210:7–12.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Landeen LB, Hultgren EM, Kapsch TM, Mallory PW. Vaginal cuff dehiscence: a randomized trial comparing robotic vaginal cuff closure methods. J Robot Surg. 2016;10(4):337–41.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Rettenmaier MA, Abaid LN, Brown JV 3rd, Mendivil AA, Lopez KL, Goldstein BH. Dramatically reduced incidence of vaginal cuff dehiscence in gynecologic patients undergoing endoscopic closure with barbed sutures: a retrospective cohort study. Int J Surg. 2015;19:27–30.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Raine-Bennett T, Tucker LY, Zaritsky E, Littell RD, Palen T, Neugebauer R, et al. Occult uterine sarcoma and Leiomyosarcoma: incidence of and survival associated with Morcellation. Obstet Gynecol. 2016;127(1):29–39.CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Spagnolo E, Bassi E, Ferrari S, Rossitto C, Campagna G, Scambia G, et al. Extra-corporeal in-bag manual Morcellation for uterine specimen extraction: analysis of 350 consecutive cases. J Minim Invasive Gynecol. 2015;22(6S):S107–8.CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Serur E, Zambrano N, Brown K, Clemetson E, Lakhi N. Extracorporeal manual Morcellation of very large uteri within an enclosed endoscopic bag: our 5-year experience. J Minim Invasive Gynecol. 2016;23(6):903–8.CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Iavazzo C, Gkegkes ID. Robotic assisted hysterectomy in obese patients: a systematic review. Arch Gynecol Obstet. 2016;293(6):1169–83.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Gynecologic OncologyCity of Hope National Medical CenterDuarteUSA

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