Alisha Ragland’s blood loss from fibroids in her uterus was so severe that she landed in Community Hospital of the Monterey Peninsula’s Emergency department — twice.
Ragland went home a day after the surgery and bears only a few small scars on her abdomen, exhibiting the benefits associated with robot-assisted surgery: minimally invasive, small incisions, faster recovery, shorter hospital stays, less blood loss, and less pain than “open” surgery.
“For anyone suffering with uterine problems, don’t wait . . . don’t be afraid of the surgery,” Ragland says. “They’ve got it dialed in. There’s no reason to suffer with these menstrual issues when something so easy exists to let us reclaim our lives.”
Hysterectomies are among more than a dozen robot-assisted procedures offered at Community Hospital. The robotic program began in 2019, focusing on gynecology and urology. It has grown in the number and types of procedures, as surgeons with expertise in other areas have joined the medical staff or current members have undergone extensive training in robotics. To meet need and demand, a second robotic system was added in 2023.
“It really is the next level of the surgical experience,” says Dr. Steven Cabrales, Vice President and Chief Medical Officer of Montage Health. “It takes the skills that we use for standard laparoscopic surgery and then refines them so the patient actually has a better surgical experience with regard to pain and discomfort.”
Ragland’s surgery followed a diagnosis of uterine fibroids — growths made of muscle cells and connective tissue that can cause bleeding between periods, longer- or heavier-than-normal periods, and cramping. She had those symptoms to an extreme degree, with periods so heavy, long, and painful that she was unable to leave the house at times.
She was referred to Clark, an obstetrician/gynecologist with Montage Medical Group, and they decided a robot-assisted hysterectomy was her best option.
While Ragland was familiar with robot-assisted surgery, Clark says that’s not always the case.
“Some patients ask, ‘Well who’s controlling the robot?’” Clark says. “I say, ‘Don’t worry. The robot doesn’t do anything without my permission. I’m the one in control.’ Most of them think it’s really cool.”
In robot-assisted surgery, the surgeon operates from a console, controlling the four arms of the “robot.” One of the arms has a state-of-the-art camera, providing high-definition, 3D images of the surgical area. The other arms have tiny surgical instruments. Each is inserted into the body through a small incision. The tools exactly mimic the hand and wrist movements of the surgeon in real time.
Cabrales says there is less pressure, tension, and torque from the instruments than with traditional laparoscopy.
“The robot puts the moveable part at the very tip of the instrument, so it’s essentially only the ‘fingertips’ that are doing any of the motions,” he says. “There’s a significant reduction in the amount of pressure on the abdomen wall and that makes a difference in post-operative pain and recovery.”
In Ragland’s case, Clark detached the uterus, placed it inside a specimen collection bag in Ragland’s abdomen, then brought the bag to the belly-button incision. While it was in the bag, she cut the uterus into strips small enough to be safely removed through the small incision.
Ragland’s uterus had become so enlarged it would have been difficult to remove through traditional laparoscopic surgery, Clark says.
“When you have a really complicated case, that’s where robotics shines,” she says. “I think our patients are really happy with the outcomes. We’re able to do the more complicated surgeries and offer a better recovery with less pain.”
Cabrales says lung surgery for procedures including lung tumor removal will be the next area added in the robotics program.
“We’re constantly looking at ways of adopting laparoscopic techniques with the robot,” he says. “People were leaving the community to go to Stanford and UCSF. They asked, ‘How come you can’t do it here?’ We can and we did, and now we’re reversing the trend, so people can continue to get the best care they need right here.”
