My doctor told me I’m a candidate for a hysterectomy. What are the issues that are considered for hysterectomy?
Several health conditions may result in the recommendation for hysterectomy. These include, but are not inclusive of uterine fibroids (benign tumors of the uterus), “falling” of the uterus causing discomfort (uterine prolapse), ovarian masses, uterine or ovarian cancer, and heavy vaginal bleeding.
What are my options when it comes to having a hysterectomy?
Several options exist. These options will depend on the comfort and skill of your gynecological surgeon. The four most common methods of approach to a hysterectomy are the abdominal approach (incision through the abdominal wall), vaginal hysterectomy (removal of the uterus through the vagina), laparoscopic hysterectomy (using instruments through tiny incisions in the abdomen to gain access to the attachments of the uterus) and robotic hysterectomy (similar to laparoscopy, but the instruments are controlled with the aid of a robot for improved maneuverability).
How do I know which method is right for me?
This answer depends on several factors. The main issues at work are your doctor’s skill set (meaning their ability to perform all of the treatment options), the size of your uterus, previous surgical history and size of your pelvis to name a few. The ultimate decision is an interplay of these (and several other) variables. However, these days, most surgeons strive to perform these cases as minimally invasive as possible.
What constitutes a minimally invasive procedure?
These procedures avoid larger abdominal incisions. With laparoscopy, the goal is to create smaller incisions in the abdominal wall (usually three to five single 5-10 mm incisions or a single 2-3 cm single incision). Trocars are then advanced through these incisions to move the operative instruments in and out of the patient’s abdominopelvic cavity. The instruments used will have different capabilities. Some instruments will be scissors, some are graspers, and some will even have accompanied energy sources that allow us to cut and stop bleeding at the same time. Vaginal surgery avoids having any abdominal incision.
Why does it matter to avoid these incisions?
Studies have shown that hysterectomies performed either through the vagina, via the laparoscope, or via the robotic mode have quicker recovery (half the time), less pain, less complications, and less blood loss. These advantages make a huge improvement in decreasing the morbidity associated with surgical removal of the uterus.
The idea is with these smaller incisions, the pain and recovery time is decreased because there is less of a fascial insult. Fascia is the layer of the abdominal wall that keeps “the insides in and the outside out.” With larger abdominal incisions, it usually takes six weeks to regenerate 95 percent of the tensile strength along the fascial incision line.
What does robotic surgery entail? Is it better than the other forms of surgery?
Robotic-assisted hysterectomy entails the use of a robot that is “docked” to the patient during a case. The robot then attaches to the external instruments via the traditional laparoscopic trocar sites. The surgeon operates from a separate console (in the same operating room) while viewing everything in 3-D. The advantage with robotic surgery is the movement of the instruments mimic the motion of the surgeons’ hands with absolute precision. Also, the instruments articulate like a surgeons’wrists similar to during an abdominal procedure. Unfortunately, with laparoscopy we are unable to have this range of motion. Robotic surgery can make otherwise difficult vaginal or laparoscopic cases possible, therefore reducing the need for an open hysterectomy. Again, the recovery time, the blood loss, and post-operative pain are significantly reduced.
Is robotic surgery proven and safe?
Robotics has been around a long time in medicine. The current technology we’ve been using has an excellent track record with respect to safety. About 95 percent of urological prostate removals are being performed with the robot now. The use in gynecology is growing markedly and is implemented in most major health science centers across the nation when deemed appropriate.
How do I decide which plan of care is right for me?
Patients are urged to have an open and thorough discussion with their doctor. Find out what your care plan is and the doctor’s reasoning for picking their route of hysterectomy. Luckily, with the advent of minimally invasive hysterectomies, fewer people should have to have a traditional abdominal incision, and most should suffer a fraction of the amount of pain and recovery time incurred with open hysterectomy.