Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:

• Physical exam
• Blood tests
• Urine tests
• Electrocardiogram (ECG, EKG) ”a test that records the electrical currents passing through the heart muscle
• Intravenous pyelogram (IVP) ”a type of x-ray that creates images of the kidney, ureters, and bladder by injecting dye into the bloodstream
• Kidneys, ureter, bladder (KUB) ”an x-ray of the abdomen
• Abdominal or pelvic ultrasound ”a test that uses sound waves to visualize the inside of the body
• CT scan ”a type of x-ray that uses a computer to create images of structures inside the abdomen or pelvis
• Dilation and curettage (D&C) ”surgical removal of tissue from the lining of the uterus to diagnose or treat gynecologic or obstetric conditions

You may need to:

• Talk to your doctor about your current medications. Before the procedure certain medications may need to be stopped such as:
  • Aspirin or other anti-inflammatory drugs for up to one week before surgery
  • Blood-thinning medications such as clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid)
• You may be asked to take a laxative and/or perform an enema. This will clean out your intestines.
• Follow a special diet, if recommended by your surgeon.
• Take antibiotics, if prescribed by your doctor.
• You may be asked to shower the night before your procedure using antibacterial soap.
• Arrange to have someone drive you to and from the hospital. Arrange for help at home as well.
• Eat a light meal the night before. Do not eat or drink anything after midnight.
• Plan to wear comfortable clothing on the day of your procedure.

Anesthesia

The type of anesthesia will depend on the type of procedure. You may receive:

• General anesthesia”you will be asleep
• Local anesthesia”the area is numbed

Description of the Procedure

The other two or three arms hold other tools. This may include dissectors, scissors, scalpels, and/or forceps. These tools are able to grasp, cut, dissect, and suture structures.

The surgeon sits at a console. The surgeon can see the abdomen image in a screen. Joystick-like hand controls and foot pedals will help to guide the tools. Another surgeon stays by you to adjust the tools as needed.

In some procedures organs or tissues are removed. The organ or tissue is dropped into a specimen bag. It can then be removed through one of the openings.

When the procedure is done, the tools are removed. The surgeon closes the incisions with sutures or staples, and applies a sterile dressing.

After Procedure

If an organ or tissue was removed, it may be sent to a lab. The lab will for examine it for any abnormalities.

How Long Will It Take?

It may last about 1-2 hours. The length depends on the type of procedure being done.

Will It Hurt?

Anesthesia prevents pain during surgery. Patients typically have pain and soreness during recovery. Pain medication will be given to relieve the discomfort. In the case of gynecologic procedures there may also be vaginal bleeding or discharge. You may also feel bloated or have pain in your shoulder from the gas used during the procedure. This can last up to three days.

Possible Complications

General:

• Damage to neighboring organs or structures including the intestines
• Infection
• Bleeding
• Anesthesia-related problems
• Sometimes it becomes necessary during the procedure to abandon the robotic method and perform the surgery using traditional methods (eg, traditional laparoscopic or open surgery)

Specific to cholecystectomy:

• Gallstones accidentally spill into the abdominal cavity

Specific to Nissen fundoplication:

• Difficulty swallowing, belching, or vomiting
• Narrowing of the esophagus requiring a subsequent procedure to dilate it

Specific to hysterectomy:

• Urinary incontinence
• Loss of ovarian function and early menopause if the ovaries are removed
• Depression
• Sexual dysfunction

Specific to myomectomy:

• Recurrence of fibroids
• Perforation of the uterus or bowel during surgery
• Weakened uterine wall
• Pelvic adhesions that can cause pain or bowel obstruction
• Infertility
• Need for special precautions in pregnancy

Talk to your doctor about complications specific to your surgery.

Average Hospital Stay

The stay is usually 1-2 days. It may be longer, depending on the procedure.

Postoperative Care

You will receive instructions on when and what you can eat, and how you need to restrict your activity. Depending on your procedure, your doctor will likely advise you to:

• Take antibiotics to help prevent infection.
• Avoid certain medications.
• Resume normal activities (eg, taking daily walks) soon, to promote healing.
• Gradually progress from a liquid to a solid diet.
• Eat a high-fiber diet , drink plenty of water, and use stool softeners if necessary to avoid constipation.
• Wash the incisions with mild soap and water.
• Limit certain activities, such as driving, walking up stairs, lifting, working, and engaging in sexual intercourse, for a period of time.