Likewise, Dr. Ribot says managing the patient's expectations before,
during and after the procedure is essential. Pre-operative counseling
includes a discussion of at-home catheter care, as 30% to 50% of
patients who undergo hysterectomy go home with a catheter because
they can't empty their bladder by the time of discharge. To date, not a
single patient has reported issues with subsequent catheter removal at
home.
"This is stuff people should have been doing since 2006," he says. "If
you're sticking to protocols like Barbara Levy's, there's certainly no
technical reason you shouldn't be doing it now."
Besides the training and mentoring needed to master the surgery,
Dr. Ribot suggests a standard endoscopic video tower, with a high-def-
inition camera and a good fiber-optic light source; standard laparo-
scopic instruments such as graspers, needle holders and bipolar for-
ceps; and an ultrasonic or radiofrequency/bipolar vessel sealer. Good
optics may help, too. He says seeing the procedure unfold on a big,
bright 4K screen would be "fantastic," but he doesn't believe it's nec-
essary. Case in point: He's using 1080p surgical displays, and "our out-
comes speak for themselves."
As for robotics-assisted hysterectomy, he says the awareness it has
created has helped to improve uptake of minimally invasive hysterec-
tomy. But it's cost-prohibitive for the ASC setting and adds to surgical
time unnecessarily. He likens it to "using a Lamborghini to do some-
thing you could do with a Ford Focus."
— Bill Donahue
4 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M a y 2 0 1 7
"I now need a good reason to
keep someone in the hospital."
— Hugo D. Ribot Jr., MD, FACOG, ACGE
