Hysterectomy
A number of different health issues might necessitate a hysterectomy, or the removal of the uterus. Issues like heavy menstrual bleeding, fibroid tumors, pelvic prolapse, cancer and severe endometriosis all may require this procedure. According to the National Uterine Fibroid Foundation, more than 600,000 hysterectomies are performed each year in the U.S.
There are various types of hysterectomy that are performed depending on the patient's diagnosis:
- Supracervical hysterectomy - removes the uterus and leaves the cervix intact
- Total hysterectomy - removes the uterus and cervix
- Radical hysterectomy or modified radical hysterectomy - a more extensive surgery for gynecologic cancer that includes removing the uterus and cervix and may also remove part of the vagina, fallopian tubes, ovaries and lymph nodes
Approaches to Hysterectomy
Surgeons perform the majority of hysterectomies using an 'open' approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6-12 inch incision. When cancer is involved, the conventional treatment has always been open surgery using a large abdominal incision, in order to see and, if necessary, remove related structures like the cervix or the ovaries.
A second approach to hysterectomy, vaginal hysterectomy, involves removal of the uterus through the vagina, without any external incision or subsequent scarring. Surgeons most often use this minimally invasive approach if the patient’s condition is benign (non-cancerous), when the uterus is normal size and the condition is limited to the uterus.
In laparoscopic hysterectomy, the uterus is removed either vaginally or through small incisions made in the abdomen. The surgeon can see the target anatomy on a standard 2D video monitor thanks to a miniaturized camera, inserted into the abdomen through the small incisions. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy alone.
While minimally invasive vaginal and laparoscopic hysterectomies offer obvious potential advantages to patients over open abdominal hysterectomy - including reduced risk for complications, a shorter hospitalization and faster recovery - there are inherent drawbacks. With vaginal hysterectomy, surgeons are challenged by a small working space and lack of view to the pelvic organs.
Additional conditions can make the vaginal approach difficult, including when the patient has:
- A narrow pubic arch (an area between the hip bones where they come together)
- Thick adhesions due to prior pelvic surgery, such as C-section
- Severe endometriosis
- Non-localized cancer (cancer outside the uterus) requiring more extensive tissue removal, including lymph nodes
With laparoscopic hysterectomy, surgeons may be limited in their dexterity and by 2D visualization, potentially reducing the surgeon's precision and control when compared with traditional abdominal surgery.
Some situations still require an open hysterectomy or a vaginal approach with laparoscopic view, but many women can now choose a robotic procedure that is often less painful, has potentially fewer complications and may cause less scarring.
To make an appointment or for more information call (575) 532-7671 or visit MyMountainViewObgyn.com
Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks and benefits of each treatment can help you make the best decision for your individual situation.