World first as heart transplant patient undergoes robotic hysterectomy

UK patient first to undergo post-transplant hysterectomy using Da Vinci robot

This is believed to be the first operation of its kind carried out on a patient who has undergone a heart transplant

A heart transplant patient is believed to be the first in the world to have undergone a hysterectomy operation performed using a surgical robot.

Nicola Dixon, 46, underwent a total robotic hysterectomy at the Royal Hallamshire Hospital in Sheffield, performed using the Da Vinci robot.

There are no other cases recorded in the medical literature of such a procedure ever having been performed on a woman who has previously undergone a heart transplant.

Robotic surgery is performed laprascopically through incisions in the abdomen, making it less invasive than traditional surgery and resulting in less blood loss and a lower risk of infection. This reduces the risks inherent in operating on a heart transplant patient.

Dixon needed a hysterectomy because she was suffering from heavy and debilitating periods that were ruining the quality of life she had regained after the transplant in 2002.

She received a new heart after being diagnosed with cardiomyopathy, a disease of the heart muscle which prevents it from pumping properly, after giving birth to her daughter.

Nicola Dixon

A resident of Everton, near Doncaster, she said: “Given my history, it was a massive decision for me to go back into hospital for another big operation, but the transplant had given me a quality of life which this issue was now destroying.

“I was losing lots of blood and having extremely-painful periods to the point where I often could not go out of the house. I had tried numerous treatments which didn't work for me and due to my medical history there were other treatments which I was unable to have. This meant my only option left was a hysterectomy.

“I knew my heart was in a good condition to have the operation, and alongside the fact that the issue could have got worse when I hit the menopause, I decided I had to bite the bullet and get it done.”

During the surgery she had her uterus and cervix removed, but retained her ovaries as they produce the hormone oestrogen which can help to protect the heart.

The procedure was performed on the Da Vinci machine by consultant gynaecological oncologist, Fiona Kew. The robot enables the surgeon, who controls the machine from a console using pedals and joysticks, to perform complex surgery through small incisions, which reduces the amount of bleeding and the risk of infection.

This was particularly important in Dixon’s case, as transplanted hearts do not respond to blood loss as quickly as normal hearts, making any excessive bleeding particularly dangerous. The heartbeat is controlled by the nervous system and adrenaline, and a normal heart will respond to any changes in the body, such as blood loss during surgery, instantaneously by pumping harder. But a transplanted heart is not wired up to the nervous system in the same way and can take several minutes to react, making blood loss a serious risk. Infections can also be more serious for transplant patients who are on immunosuppressant drugs.

Kew said: “Nicola had tried all the other available treatments for heavy periods, but they had not worked. The surgery was the only remaining option. It is a relatively-common procedure and I am used to performing it, but with Nicola there were added risks to consider. We did lots of planning beforehand to make sure we were fully prepared for any eventuality.”

In the event the surgery, which took about 75 minutes, went smoothly and she was allowed to return home after just one night in hospital. The recovery period is six to eight weeks and Dixon, a keen golfer, aims to be back playing in time for the summer season.

She said: “It has made a massive difference and the recovery period has been miles better than I thought it would be. I am mad about golf and getting fit to play again has been a real target for me. I have also been out walking with my boxer dog and I am no longer suffering from migraines I used to get with my period, which is huge for me as they were quite debilitating.

“I was stunned when I was told this was the first operation of its type. It is really amazing and I would not discourage anyone in a similar position from going for it.”

Kew is now planning to write up the case and publish it in a journal of robotic medicine.

“It will enable other surgeons to have that learning knowledge,” she said.

“But I think it also shows other transplant patients that they can get on and receive the medical care they need and still live a relatively-normal life.”

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