Times have changed. The surgical process for a hysterectomy is now very different.Just last week the FDA issued a warning about cutting tools used to remove uterine fibroids during a laparoscopic supra-cervical hysterectomy. Many women facing a hysterectomy may have questions about how this relates to them. We'll explain that in full below. It's yet another example of how things have changed for the process of hysterectomies - the second most frequent surgery for women.
In years past, when a woman had a hysterectomy she could expect a number of things. First, she often had a 5" – 7" incision across her abdomen - indicating what we now call an "open hysterectomy." Her stay in the hospital extended for a number of days following her surgery. Post-surgical pain was extreme and it often took months before she started to feel like herself again. Many activities were severely restricted during the long recovery.
During the past decade, everything about having a hysterectomy has changed. Fortunately, the experience your mom or grandmother had is a thing of the past. This is what you need to know now.
What is a hysterectomy?Hysterectomy is a surgical procedure to remove the uterus. Commonly I will recommend a hysterectomy if the woman is experiencing severe abdominal pain due to endometriosis or uterine fibroids, excessive bleeding, chronic abdominal pain or if the uterus has moved from its usual position – a condition known as a prolapse of the uterus. Other less frequently encountered situations may also call for a hysterectomy as the best course of treatment.
What is minimally invasive surgery? What does it mean for me?While rare cases may call for an open hysterectomy, in my practice more than 99% of the hysterectomies I perform are minimally invasive procedures. This means that the surgery is performed with a much smaller incision. In real terms, for you as a patient, this means a faster recovery time and less pain.
These are the basic types of hysterectomies that are considered to be minimally invasive:
Vaginal Hysterectomy: For several decades, physicians have been routinely performing vaginal hysterectomies. This is where an incision is made in the vagina and the uterus is removed through this incision. There is no incision visible on the abdomen.
Laparoscopic Hysterectomy: During this procedure, several small incisions are made in the abdomen. A lighted instrument with a camera is inserted through one of the incisions. The uterus is cut into small pieces and removed through the incisions. (Please note: this is a total laparoscopic hysterectomy and IS NOT the type of surgery for which the FDA has issued a warning. Please read more below.)
da Vinci® Robotic Assisted Hysterectomy: In my practice, I use the da Vinci Surgical Robot for most of the hysterectomies I perform. This system allows me to use much smaller incisions and smaller surgical tools. This is the difference in incision size between an open hysterectomy and a da Vinci hysterectomy:
For my patients, there’s less pain, less blood loss during surgery and a much faster recovery.
Benefits of Minimally Invasive da Vinci Hysterectomy:The da Vinci System includes a 3D high definition system which allows me to operate with an unequalled view of the abdominal area. The state-of-the-art surgical tools are controlled by me and offer more precision and control than other comparable minimally invasive procedures. The system allows me to perform highly complex surgeries without the large incision that was previously required for this kind of surgery.
Over the years I have been operating with the da Vinci system, I have found a number of benefits for my patients with this process. This includes:
• Shorter hospital stays
• Less post-operative pain
• Less blood loss during surgery
• Faster recovery
• Minimal scarring
News flash: what does the FDA warning on hysterectomies mean?In a major safety advisory released last week, the Food and Drug Administration discouraged surgeons from using a powered cutting tool to remove uterine fibroids. This has a profound impact on doctors and patients relying on laparoscopic supra-cervical hysterectomy. This is NOT the laparoscopic surgery we've described above.
With laparoscopic supra-cervical hysterectomy, the surgery the FDA has warned about, the uterus in removed from the cervix but the cervix remains in place. As a result the only way to remove the uterus is through the small laparoscopic incisions. Given the small size of these incisions, the uterus has to be morcellated (cut into pieces) inside the abdomen to be removed. For more than 99% of women this is not a problem. However, for the 1/350 women with a fibroid that turns out to be an unsuspected sarcoma (cancer); cutting the uterus into pieces inside the abdomen results in worsening prognosis by spreading the cancer.
This can all be avoided by seeking out a doctor with the skills to provide a total laparoscopic hysterectomy. This provides the minimally invasive approach with fast recovery, can conserve the ovaries and remove the uterus without morcellation. Dr. Ashford has been one the first surgeons performing such procedures with and without a robot in Minnesota.
In conclusionIf your physician has recommended a hysterectomy, I would encourage you to find out if this surgical process is right for you. My patients have been pleasantly surprised by their fast recovery and how different their experience was from their mother or grandmother. It’s really gratifying to me as a physician to be able to bring relief to women after years of suffering from painful conditions and to do so in a way that provides for a smooth recovery and a faster return to their busy lives.
Melvin Ashford, M.D.