Hysterectomy -Basic Background:

When a patient and surgeon have agreed that a hysterectomy is the best next step, there are different approaches to physically removing the uterus. Safe surgery of internal organs always requires that the surgeon is able to see the structures she is operating on, and that - in abdominal surgery, was traditionally accomplished by making a large incision through the skin and muscles, pulling these sheets of tissue out of the way with retractors, and then carefully lifting and separating out the blood vessels nerves and veins , and other organs, on the way to identifying the part of the body that required removal (excision) or manipulation. For hysterectomy, this involved rather large incisions and subsequently, the healing process was required not simply for healing over the bits of tissue that were the internal "setting" of the uterus, but in healing through-and through cuts in the belly and/or vagina that were of a substantial area.

Laparoscopic Surgery:

The optical teloscope was invented and applied to intra-abdominal surgery. The telesope allows the surgeon to see the tissues he is operating on under excellent light and perfect visibilty without doing more than inserting the telescope through a "stab incision". Other such stabs must be made for the long handled instruments, and one for a pipe called a cannula that will transmit gas to stretch the abdominal cavity enough to give room to work.

Robotics in Laproscopic surgery: Certain surgical maneuvers, like suturing, could be accomplished in laproscopic surgery- but had a "different feel" to them than operating directly through a large incision, and in some specific situations, the angles and techniques were so difficult that the better part of valor was to perform the traditional open operation.

Hysterectomy
Hysterectomy is the surgical excision of the uterus. Common variations of the procedure:

1) According to exactly what is removed:

2) According to the methods and route of surgical removal

Hysterectomy is the surgical removal of the uterus. Always major surgery, the ramifications of this operation are different depending on whether it is done on a woman who desires future children, and whether it includes an additional procedure: excision of the ovaries.

Removal of the uterus before menopause removes a woman's childbearing ability. However, if her ovaries are intact and functioning, even without a womb, it is technically possible for her to have a biological child. That would require the harvesting of her ova and assisted reproduction with a surrogate, another woman who would allow the fertilized ovum (zygote) to develop in her uterus.

Removal of the ovaries is not strictly part of hysterectomy, but is often indicated when a woman has a condition that warrents hysterectomy. When the ovaries and uterus are removed in the same procedure, that's called an oopherectomy and hysterectomy, when the ovaries and the tubes that ordinarily carry ova to the uterus are removed along with the uterus, then it's oosalpigohysterectomy.

The uterus, as far as known, is strictly a reproductive organ - that's true, too of the fallopian tubes, the "adnexa". But the ovaries are a part of the endocrine system, and that part is played out beyond the childbearing years.

Hysterectomy Alone

The surgical removal of the uterus can be done effectively through conventional surgery techniques with an approach through an abdominal incision or vaginal incision, or both. It can also be accomplished in a minimally invasive manner, using the technique of laparoscopic surgery.

Rate of major complications is higher in laparoscopic than abdominal hysterectomy but, when hysterectomy is done for appropriate indications - quality of life improves after both kinds of procedures. (Learman 2004)

The usual recovery is much faster after laparoscopic surgery than conventional surgery - but currently, the great majority of hysterectomies are performed by conventional open techniques. Few surgeons are comfortable with performing the operation solely with laparoscopic instruments, however the procedure may become safe in more surgeon's hands with the use of robotic assistance, such as the da Vinci system. Whether, with such a system, the complication rate will become reduced to - or below- that of conventional hysterectomy remains to be proven.
Bibliography (References)
Learman L - Evidence-based Healthcare. - August 1, 2004; 8(4); 232 (Does not compare robotic assisted laparoscopy - only "free-hand laparoscopy" and conventional surgery)