I had another equally exciting week in OB/GYN world!  This week was spent with me actually doing work, annual exams, burning genital warts, birth control counseling, sexual dysfunction counseling, and lots of OB measurements.  I added a few new things to my plate again this week, a laparoscopic-assisted vaginal hysterectomy (LAVH) and a robotic vaginal hysterectomy.  The LAVH took just over an hour to do.  We made 2 one inch incisions on the belly for instruments and one in the belly button for the camera, cut the uterus, fallopian tubes, and ovaries separate from the lining and ligaments, and then pulled everything out through the lovely built in opening between the legs.  All went well.  The robot, called the da Vinci, stands about 8 feet tall and 5 feet wide.  The physician sits a screen with the controls a few feet from the table.  The assistants around the table are there to switch out instruments, introduce suction, and irrigate the tissues through one of the 4 belly holes.  The surgery was done with 4 one inch incisions on the belly for the robotic arms and one in the belly button for the camera.  There was also a manipulator placed onto the uterus from between the legs.  This procedure was very similar to the LAVH, but the benefits to the robot are less bleeding and less recovery time for the patient.  However, this turned into a 4 1/2 hour procedure because the uterine manipulator came apart and was no longer a manipulator, thus blocking the view of the physician.  We did finally finish and all was well.  I was able to see another robot done the next day and this one went just as planned and we finished in under 3 hours, which was her best time and easiest case yet to date.  She is one of the few physicians to use the robot and has only completed 7 cases so far.  Talk about evolution of technology!  Abdominal hysterectomies are frowned upon nowadays and it was just a few years ago that they were standard!  The belly lacerations are sewn with internal stitching so I was also able to scrub in and help sew!