Minimally invasive surgery
Robot Assisted Gynaecological Procedures
Complex pelvic and cancer surgery performed through small incisions, with the surgeon in control throughout.
Robot-assisted gynaecological surgery is an advanced form of minimally invasive, keyhole surgery that allows complex procedures to be performed through small abdominal incisions.
Mr Jafaru Abu specialises in laparoscopic and robot-assisted gynaecological surgery, including hysterectomy, comprehensive surgical staging, uterine cancers and selected early ovarian cancers.
Robotic surgery can be particularly valuable when an operation requires detailed dissection in the pelvis, precise suturing or access to difficult-to-reach areas. The technology gives the surgeon a magnified, high-definition view and allows specialised instruments to make controlled movements within the body.
Importantly, the robot does not perform the operation by itself. The surgeon remains completely in control throughout the procedure.
What is robot-assisted gynaecological surgery?
Robot-assisted surgery is a type of laparoscopic or keyhole surgery.
Instead of the surgeon holding the laparoscopic instruments directly, the instruments are attached to robotic arms. The surgeon sits at a console next to the operating table and controls the instruments using hand and finger movements.
A high-definition camera provides a magnified three-dimensional view of the surgical area.
The robotic system translates the surgeon's movements into precise movements of the small instruments inside the body.
The robot therefore acts as an extension of the surgeon's hands, it does not make decisions or operate independently.
How does robotic surgery work?
Robot-assisted surgery is usually performed under a general anaesthetic.
Several small incisions are made in the abdomen. The robotic camera and specialised instruments are inserted through these small openings.
The surgeon then sits at the robotic console and controls the instruments.
The system can provide:
- High-definition, magnified visualisation
- Three-dimensional views of the surgical field
- Precise instrument control
- A wide range of instrument movement
- Fine movements in confined areas of the pelvis
- Enhanced control during complex dissection and suturing
The surgeon remains responsible for every movement and decision throughout the operation.
Why use robotic surgery in gynaecology?
The pelvis contains several important organs and structures in close proximity, including the womb, bladder, bowel, ureters, blood vessels and nerves.
Some gynaecological operations require very precise dissection around these structures.
Robotic technology can be particularly helpful during complex surgery because it combines a magnified three-dimensional view with highly manoeuvrable instruments.
This can make certain technically demanding procedures more accessible through a minimally invasive approach.
However, robotic surgery is not automatically the best option for every patient. The most appropriate surgical technique depends on your diagnosis, the complexity of the operation and your individual circumstances.
Which gynaecological procedures can be performed robotically?
Robot-assisted surgery can be used for a range of gynaecological procedures.
Mr Abu's specialist interests include robotic surgery for:
- Hysterectomy
- Uterine and endometrial cancers
- Comprehensive surgical staging
- Selected early ovarian cancers
- Complex pelvic surgery
- Selected fertility-sparing procedures
- Other advanced minimally invasive gynaecological procedures
The exact procedures suitable for robotic surgery will depend on the individual patient and the surgical team.
Robotic hysterectomy
A hysterectomy removes the womb.
Depending on the reason for surgery, the cervix, fallopian tubes and ovaries may also need to be removed.
A robotic hysterectomy is performed through small abdominal incisions rather than the larger incision associated with an open abdominal hysterectomy.
For selected patients, robotic surgery can be particularly useful where the operation involves complex pelvic dissection.
The precise operation will depend on whether the hysterectomy is being performed for a benign condition or cancer. See also total laparoscopic hysterectomy.
Robotic surgery for endometrial cancer
Endometrial cancer is cancer of the lining of the womb.
Surgery is an important part of treatment for many women with endometrial cancer and commonly involves hysterectomy, with removal of the fallopian tubes and ovaries where appropriate.
Depending on the cancer's characteristics and stage, lymph nodes may also need to be assessed.
Laparoscopic and robotic approaches can provide minimally invasive options for appropriately selected patients. NICE recognises laparoscopic hysterectomy as an established approach for endometrial cancer, with the potential advantages of smaller incisions, shorter hospital stay and shorter recovery compared with open surgery.
The exact approach is determined by the individual cancer and the patient's circumstances.
Robotic surgical staging
Surgical staging is an important part of treating some gynaecological cancers.
It involves assessing the areas where cancer could have spread and, where appropriate, removing tissue or lymph nodes so that they can be examined by a pathologist.
Depending on the cancer, staging surgery may involve:
- Hysterectomy
- Removal of the fallopian tubes and ovaries
- Sentinel lymph node assessment
- Pelvic lymph node surgery
- Para-aortic lymph node assessment
- Biopsies of surrounding tissues
- Other procedures required to determine the extent of disease
For some patients, robotic surgery can allow complex staging procedures to be performed using a minimally invasive approach.
The extent of staging required depends on the type and stage of cancer and the findings from imaging, biopsy and surgery.
Robotic surgery for early ovarian cancer
Selected women with apparently early ovarian cancer may be suitable for minimally invasive surgery, depending on the size and characteristics of the ovarian mass and the need for comprehensive staging.
Surgery for early ovarian cancer may involve removal of the affected ovary and fallopian tube, or both ovaries and the womb depending on the circumstances, together with appropriate surgical staging.
Staging can include assessment of lymph nodes, the abdominal lining and other areas where ovarian cancer can spread.
NICE recommends retroperitoneal lymph node assessment as part of optimal staging when ovarian cancer appears to be confined to the ovaries, although systematic block dissection of all retroperitoneal lymph nodes is not recommended as standard in every apparent stage 1 case.
Whether robotic surgery is appropriate depends on the individual case.
A large, complex or suspicious ovarian mass may require an open operation so that it can be removed safely and, where appropriate, intact.
Can robotic surgery be used for cervical cancer?
Robotic surgery can be used for selected cervical cancer procedures, although the suitability of minimally invasive surgery depends on the stage and characteristics of the cancer.
For selected early cervical cancers, surgery may involve a radical hysterectomy and pelvic lymph node assessment.
Robotic assistance can be used for some minimally invasive radical hysterectomy procedures. NICE describes robotic systems as one way of assisting minimally invasive radical hysterectomy.
However, the choice between surgery, radiotherapy and different surgical approaches requires specialist assessment.
The priority is always effective cancer treatment rather than using robotic surgery simply because the technology is available.
What are the potential benefits of robotic surgery?
For appropriately selected patients, robot-assisted surgery can offer many of the benefits associated with minimally invasive surgery.
These may include:
Smaller incisions
Robotic surgery is performed through several small abdominal incisions rather than a large open incision.
Less visible scarring
The small incisions generally result in smaller scars than open surgery.
Detailed visualisation
The surgeon operates using a magnified, high-definition view of the surgical field.
Precise instrument movement
The robotic instruments are designed to allow controlled movements in confined areas.
Potentially faster recovery
Because the abdominal incisions are smaller than those used for open surgery, recovery may be quicker for appropriately selected patients.
Potentially shorter hospital stay
Many patients undergoing minimally invasive surgery can leave hospital sooner than patients recovering from equivalent open procedures.
However, these benefits cannot be guaranteed and depend on the procedure, the patient's health and whether complications occur.
Is robotic surgery better than conventional laparoscopy?
Not necessarily.
Both robotic and conventional laparoscopic surgery are minimally invasive techniques.
Robotic surgery provides the surgeon with additional technological features, such as three-dimensional visualisation and highly articulated instruments, which can be particularly useful during technically demanding procedures.
For simpler operations, conventional laparoscopy may provide an equally appropriate approach.
The right operation is not determined by the technology alone. Your surgeon will consider the safest and most effective approach for your particular diagnosis.
Is robotic surgery suitable for everyone?
No.
Robot-assisted surgery is not suitable for every patient or every procedure.
Your suitability may depend on:
- The condition being treated
- The stage and extent of any cancer
- The size and location of a tumour or ovarian mass
- Previous abdominal or pelvic surgery
- Extensive adhesions
- Your general health
- Your body anatomy
- The complexity of the planned procedure
- Whether the tissue needs to be removed intact
- Whether an open operation would provide safer access
A specialist assessment is therefore essential.
What happens before robotic surgery?
Before your operation, you will have a detailed consultation and pre-operative assessment.
Depending on your circumstances, this may include:
- Review of your medical history
- Physical examination
- Ultrasound
- MRI, CT or PET-CT
- Biopsy or other diagnostic tests
- Blood tests
- Anaesthetic assessment
- Discussion with the multidisciplinary team if cancer is involved
Your surgeon will explain:
- Why surgery is recommended
- What the operation involves
- What will be removed
- Whether lymph nodes need to be assessed
- Whether your ovaries can be preserved
- Potential benefits and risks
- Alternative surgical approaches
- Possible need to convert to open surgery
- Expected recovery
You will have the opportunity to ask questions and make an informed decision about your treatment.
What happens during a robotic operation?
Once you are under a general anaesthetic, several small incisions are made in your abdomen.
The robotic camera and instruments are inserted through these incisions.
The surgeon then sits at the robotic console and controls the instruments.
The operation is performed in much the same way as conventional laparoscopic surgery, but with the additional capabilities of the robotic platform.
At the end of the procedure, the instruments are removed and the small incisions are closed.
The exact operation will depend on what is being treated.
What happens if robotic surgery is not possible?
Your safety always comes first.
Occasionally, the surgeon may decide during an operation that it is safer to use conventional laparoscopy or convert to an open operation.
This may happen because of:
- Significant bleeding
- Extensive adhesions
- Unexpected anatomy
- A large or complex tumour
- Unexpected spread of cancer
- Difficulty safely accessing the surgical area
- The need to remove a mass intact
Changing the surgical approach is a safety decision and does not mean that the robotic procedure has failed.
What are the risks of robotic gynaecological surgery?
Robotic surgery carries the general risks associated with surgery and anaesthesia, as well as risks specific to the procedure being performed.
These may include:
- Bleeding
- Infection
- Blood clots
- Anaesthetic complications
- Injury to the bowel
- Injury to the bladder
- Injury to the ureters
- Injury to blood vessels
- Nerve injury
- Wound problems
- Formation of adhesions
- Lymphoedema following lymph node surgery
- Need for additional surgery
- Conversion to conventional laparoscopy or open surgery
The risks vary considerably according to the type and complexity of the operation.
Your surgeon will discuss your individual risks before surgery.
What is recovery like?
Recovery following robotic surgery varies depending on the procedure.
You may experience:
- Abdominal discomfort
- Tiredness
- Bloating
- Temporary changes in bowel or bladder function
- Shoulder-tip discomfort caused by the gas used during laparoscopy
- Bruising or tenderness around the small incisions
You will normally be encouraged to move around as soon as it is safe to do so.
Walking helps reduce the risk of blood clots and supports recovery.
Your team will advise you when you can return to driving, work, exercise and other normal activities.
More complex cancer procedures may require a longer recovery than a straightforward robotic hysterectomy.
Will robotic surgery affect fertility?
This depends entirely on the operation being performed.
A hysterectomy removes the womb and therefore means that pregnancy cannot be carried afterwards.
However, some fertility-sparing procedures can be performed using minimally invasive or robotic techniques in carefully selected patients.
For example, robotic assistance may be used during some fertility-sparing procedures for early cervical cancer.
Where preserving fertility is important to you, this should always be discussed before treatment begins.
The safety of your cancer treatment must remain the first priority, but where fertility preservation is medically possible, your options should be explored with you.
Robotic surgery and lymph node removal
Some gynaecological cancer operations involve assessment or removal of lymph nodes.
These may include:
- Sentinel lymph node biopsy
- Pelvic lymphadenectomy
- Para-aortic lymph node assessment
Robotic surgery can allow lymph node surgery to be performed through small abdominal incisions in appropriately selected patients.
However, not every patient needs lymph node surgery, and the extent of lymph node assessment depends on the type and stage of cancer. See also lymphadenectomy.
Why specialist expertise matters
Robotic surgery is an advanced form of minimally invasive surgery. The technology itself does not replace surgical expertise.
The surgeon needs to understand complex pelvic anatomy, cancer surgery principles and minimally invasive techniques in order to use the technology safely and effectively.
Mr Jafaru Abu has a particular specialist interest in minimally invasive and robotic gynaecological surgery. His experience includes complex keyhole procedures, total laparoscopic hysterectomy, fertility-sparing surgery and gynaecological cancer surgery. Gynae Solution also describes his work in developing advanced robotic surgery and women's cancer programmes during his time in Abu Dhabi.
A personalised approach to robotic surgery
Robotic surgery is not about choosing the most advanced technology simply because it is available.
It is about determining whether that technology can provide a genuine benefit for your particular operation.
At Gynae Solution, Mr Abu will assess your diagnosis, scans, medical history and treatment goals before recommending the most appropriate surgical approach.
This may be robotic surgery, conventional laparoscopy, single-incision surgery, vaginal surgery or an open procedure.
The aim is always the same: safe, effective treatment with the least invasive approach that is appropriate for you.
Book a consultation
If you have been advised that you may need gynaecological surgery and would like to understand whether robot-assisted surgery could be appropriate for you, a specialist consultation can help you understand your options.
Mr Abu and his team will explain your diagnosis, the proposed operation, the potential benefits and risks, alternative approaches and what you can expect during recovery.
You will have the opportunity to ask questions and make an informed decision about your care.
Patient leaflets
Written for patients, relatives and hospital personnel, to read before your operation and to keep afterwards.
Common questions
How soon can I be seen?
Daily appointments are available at The Park Hospital. Call the secretary on 0115 966 2049, or send an enquiry below and we will reply within 24 hours on business days.
Do I need a GP referral?
Referrals from GPs are welcome, and you can also enquire directly. If you are using private medical insurance, check with your insurer whether a referral is required for your policy. See GP referrals and fees and insurance.
What does a consultation cost?
A new consultation is £250 and a follow-up consultation is £150. The cost of any tests, procedures or surgery is quoted individually after your consultation. See fees and insurance.
Enquiries
Send us a message
Enquiries from patients and referring clinicians are both welcome. We endeavour to answer all enquiries within 24 hours on business days. If your case is urgent, please say so in your message or call the secretary directly.