Complex Robotic Hysterectomy: Tackling the Bladder with Previous Cesarean Section

Laparoscopic Hysterectomy was first described in 1989 by Harry Reich. Robotic Hysterectomy is increasingly being adopted as a minimally invasive option for hysterectomy. With increase in caesarean rates, the rates of bladder complications are likely to increase. The advantages to a surgeon with robotics is a magnified (10X) stereoscopic binocular vision, wristed movements at the end of the operative instruments, intuitive motion of the instruments in the pelvis, near control of the surgical field and tremor filtration. This chapter aims to discuss a simple reproducible Sinha Apollo technique- A “Two arm Three instruments” for doing robotic hysterectomy and the strategies to tackle captive uterine syndrome and dense bladder adhesions. Three approaches are described- Head on Approach; Lateral Window approach and Reverse Bladder dissection. Although technology helps in performing the surgery, the knowledge of anatomy and the identification of correct dissection planes will help prevent such complications.