Robotic Bilateral Salpingo-oophorectomy

A robotic bilateral salpingo-oophorectomy (BSO) is when laparoscopic (keyhole) surgery is performed using robotic assistance to remove the tubes and ovaries.

The method of performing a salpingo-oophorectomy by means of keyhole surgery at UCLH is an established technique. Laparoscopic procedures are generally preferred to ‘open’ procedures (where a bigger cut is needed on the tummy), as the recovery is faster. Robotic surgery involves the use of robotic arms to perform the laparoscopic procedure and enables surgeons to operate with enhanced vision, precision, and control. The procedure is performed by the surgeon, not the robot, who manipulates the robotic arms.

Robotic bilateral salpingo-oophorectomy is performed under general anaesthesia. It involves use of a number of "ports" or small incisions which allow access to the tubes and ovaries.

Whether you have a traditional laparoscopic procedure, or a robotic procedure, there is a small chance that your procedure may need to be converted to an open operation. Once the operation begins the surgeon may find that it is not possible to proceed through the keyholes and so may need to make a larger incision in your tummy to remove the tubes and the ovaries. Your healthcare professional will be able to guide you how likely this is.

Advantages of robotic bilateral salpingo-oophorectomy are:

• Fewer complications.
• Less blood loss.
• Enhanced surgical 3D vision and dexterity of instruments – gives the surgeons high levels of control within the abdomen.
• Lower risk of conversion to open surgery.

Robotic surgery and laparoscopic surgery have both been used for many years. The gynaecology cancer team at UCLH have carried out robotic laparoscopic surgery for several years with excellent results. Since July 2023 we have introduced this technique for our non-cancer patients who need an operation for other reasons, because we believe it will improve the outcomes and reduce complications for patients. The surgical team have been trained to use the device and the robot technical team are available to support every procedure.

All treatments and procedures have risks. We will talk to you about the risks of robotic hysterectomy and answer any questions you may have.

Problems that may happen during the operation

During the operation, there may be accidental injury to the ureters (the tubes that drain urine from the kidney into the bladder), the bladder or the bowel. Repairing these injuries may require conversion to an open procedure (with a bigger cut on the tummy) and a longer operation time, as well as a more prolonged recovery.

Usually, these injuries are identified at the time of the operation and repaired immediately. However, sometimes these injuries are small and are missed, and only get noticed when you become unwell in the days following the operation. If this is the case you may need a second operation. After any operation, you are more at risk of developing blood clots in your legs or lungs.

In the long term there is a small risk of developing a hernia after this operation. Anaesthetic and cardiovascular complications are rare during or after this type of operations.

If you choose not to have a robotic salpingo-oophorectomy, you may be offered a traditional laparoscopic salpingo-oophorectomy.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with robotic surgery, we will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves.

The medical team will explain all the risks, benefits, and alternatives, and invite you to ask any questions, before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak with a senior member of the medical or nursing team again.

The Preoperative Assessment Clinic (PAC)

A few weeks before your surgery you will be asked to attend a preoperative assessment appointment. This can be by telephone, or in person in the hospital. You will be asked questions about your health, medical history and home circumstances. Some tests may also be required, for example blood tests, or an ECG (a tracing of your heart rhythm).

You will be given information about the morning of your surgery: when to stop eating and drinking, and if you need to stop taking any of your regular medications.

The day of your surgery

You will receive instructions about the time of your admission, and where to go. If you do not receive these, please contact your team using the contact details below.

During robotic salpingo-oophorectomy, your surgeon makes several small incisions (usually three to four), then uses a 3D high-definition camera for a crystal clear, magnified view of the inside of your pelvis.

The surgeon then sits at a console next to you and operates through the incisions using tiny instruments and the camera. Every hand movement your surgeon makes is translated in real time by the robotic system which bends and rotates the instruments so your surgeon can remove your tubes and ovaries.

The skin incisions (cuts) are then closed with stitches or special glue as for any other surgery.

We will encourage you to get out of bed soon after your surgery. You will be discharged once you are eating, drinking, passing urine, mobilising safely, and your pain is well-controlled on oral tablets. Occasionally your surgeon may recommend that you stay in hospital a little longer, especially if your surgery was difficult or there were complications.

It is important that someone is available to help you get home when you are discharged (e.g., to help carry your bag etc). It is also important that there is someone to help look after you at home. You will need to plan in advance for the fact that you won’t immediately be able to do things you usually would do at home, including driving. We would suggest that you plan to be off work for two weeks. You may feel able to go back sooner, or you may need longer if your job is very active, or if there were complications.

If you develop the following symptoms once you get home, you should go to your nearest Accident and Emergency Department. They can be signs of complications, for which you may need urgent treatment.

• High fever.
• Pain in the abdomen that is getting worse.
• Swelling of the abdomen that is getting worse.
• Being unable to pass urine, or passing very little.
• Swelling, redness, or tenderness in the lower legs.
• Difficulty breathing, or chest pain.

If your ovaries are removed before you had reached the menopause, you are likely to experience new menopausal symptoms. These include hot flushes, night sweats, vaginal dryness and brain fog. To help with these symptoms, and also to protect the strength of your bones (for which the hormone oestrogen, produced by the ovaries, is important), we will discuss the option of HRT (hormone replacement therapy).

• https://biargs.org.uk/patient-education
• https://www.intuitive.com/en-us/patients/da-vinci-robotic-surgery

Advice on menopause and HRT:

• Women's Health Concern

Please contact us in case of any further queries throughout your care. Email: uclh.gynaeadmissions@nhs.net

Alternatively, you may reach us via MyChart UCLH application using direct message. Please allow at least 72 hours for a reply.

Ward T7 South (if your next of kin wants an update on how you are immediately after the operation, or if you have non-urgent queries when you go home).

Tel: 020 3447 7828 or 020 3447 0712

Pre-operative assessment clinic (PAC) (if you have questions about how to prepare for the operation)

Tel: 020 3347 2504

Surgical reception (if you are running late on the day of your operation) Tel: 020 3447 3184 or 07939 135323

University College Hospital

235 Euston Road, London NW1 2BU Switchboard: 020 3456 7890