Why Abdominal Surgery may not be the answer
By the age of 60, one in three women will have a hysterectomy
Unfortunately, many women undergo the most invasive procedure to accomplish a hysterectomy called an abdominal hysterectomy. This procedure requires an incision in the abdomen that often results in a large scar. Abdominal hysterectomies are unnecessary for the majority of cases and cause increased pain, additional time in the hospital, and a longer recovery time for hundreds of thousands of women every year in the United States.
The healing time is two to three times less with vaginal and laparoscopic approaches to hysterectomy and has far reaching economic benefits for both the individual patient as well as society.
So, what other hysterectomy choices do women have?
Total Abdominal Hysterectomy (TAH) – performed with an “open” abdominal incision
Total Vaginal Hysterectomy (TVH) – performed with a vaginal incision
Laparoscopic Assisted Vaginal Hysterectomy (LAVH) – a combination of a laparoscopic and vaginal hysterectomy
Total Laparoscopic Hysterectomy (TLH)– performed with small incisions in the abdomen and special laparoscopic instruments are used
Laparoscopic Supracervical Hysterectomy (LSH) – a laparoscopic procedure where top part of the uterus is removed at the level of the cervix.
Robotic Assisted Hysterectomy (Supracervical or Total Hysterectomy) – the DaVinci Robot is used to assist the surgeon to accomplish a minimally invasive surgery with four or five small abdominal incisions.
There are Pros and Cons to Laparoscopic Supracervical Hysterectomy
This is when the uterus is removed and the cervix is left in place. The most compelling reason to keep the cervix is to decrease the healing time with a quicker return to normal functioning. It is important to explore this option with the surgeon to determine if you are a candidate for this approach. Many women are choosing to retain their cervix when they have a minimally invasive hysterectomy. The downside of a supracervical approach to hysterectomy is that women still need to have pap smears to screen for cervical cancer and in a very small percentage of women, there is cyclic bleeding which is often like a “mini-period”.
Surgical treatment for cervical cancer involves a radical hysterectomy where the upper part of the vaginal and lymph nodes are removed. With cancer of the ovaries and uterus a staging procedure is also performed and involves removal of the ovaries along with the lymph nodes the uterus. Young women with ovarian cancer may be able to conserve their uterus if they are interested in future childbearing.
Should ovaries be removed at the time of a Hysterectomy?
This is another important choice at the time of a hysterectomy. A total hysterectomy means that the entire uterus is removed. Whether or not the ovaries are removed at the time of a hysterectomy is a different option and should also be discussed. The medical term for the removal of the tubes and ovaries is bilateral salpinoophorectomy. Current studies show that ovaries should not be removed without an indication unless the patient is 65 years or older.
For women with a family history of ovarian cancer or who have the BRCA gene mutation, there are benefits to having the ovaries removed at the time of hysterectomy. It may also be recommended for patients with breast cancer in order to decrease their risk of recurrence or spread of the breast cancer.. It is often required to remove the ovaries in the case of gynecologic cancers and certain benign conditions, such as endometriosis.