Hysterectomy
Laparoscopic Hysterectomy
Hysterectomy is the removal of the uterus, or womb.
Hysterectomy can be accomplished with, or without, the removal of the ovaries (a procedure called an oophorectomy). If the ovaries are preserved at the time of surgery, a woman will not go into menopause.
At CGS, we specialize in laparoscopic hysterectomies. Using highly advanced surgical techniques, we are able to remove even very large uteri through the smallest incisions possible—only 5mm each. We are among the only surgeons in the world who offer the DualPort hysterectomy, which is nearly scarless.
Laparoscopic hysterectomies are always performed under general anesthesia. A camera is introduced into the abdomen, usually through the umbilicus (the navel). Carbon Dioxide gas is used to distend the abdomen in order to allow us to see inside. Depending on the nature of the particular case, we will place 1-3 additional 5mm ports in order to proceed.
Once the ports are placed, specialized laparoscopic instruments are used to detach the uterus from within the pelvis, and to seal and cut the major blood supply to the uterus. After the uterus is completely detached it is removed through the vagina. This approach allows us to use the smallest incisions and minimize the recovery period.
Frequently Asked Questions:
Should I keep my Cervix?
Current research does not show any advantage in postsurgical outcomes such as pain or recovery time. Contrary to popular belief, there is no difference in drop down or prolapse of the vagina, urinary incontinence, urinary frequency, sexual desire, frequency of sex, quality or frequency of orgasm, or body image. Women who choose to keep their cervix may be at risk for future complications involving their cervix and may require additional surgery.
There are several advantages to removing the cervix: the risk for cervical cancer is minimized, bleeding will not occur from the glands of the cervix, and all incisions are only 5mm (1/4 inch) in size. Up to 30% of women who opt to keep their cervix may continue to have monthly spotting until they go through menopause. They will also need to continue to get regular pap smears to screen for cervical cancer.
This has been known for years, yet some doctors who may not be as skilled laparoscopically have been offering the supracervical approach as an alternative to a total hysterectomy. The American College of Obstetrician Gynecologists published a Committee Opinion specifically to address this issue in 2007 and reaffirmed it in 2010. Their conclusion cannot be more clear:
“Patients electing supracervical hysterectomy should be carefully screened preoperatively to exclude cervical or uterine neoplasm [cancer] and should be counseled about the need for long-term follow-up, the possibility of future trachelectomy [removal of cervix], and the lack of data demonstrating clear benefits over total hysterectomy. The supracervical approach should not be recommended by the surgeon as a superior technique for hysterectomy for benign disease”
A summary of this committee opinion can be accessed here:
http://www.acog.org/from_home/publications/press_releases/nr11-01-07.cfm
My doctor told me I am not a candidate for a Laparoscopic approach, is that true?
Some doctors will say you are not a candidate for laparoscopic surgery because they do not have the skills or experience needed. At CGS, we can handle almost any case laparoscopically, including very large size fibroids, history of prior surgery, or large pelvic masses.
Do you use a Robot to help you do surgery? (More information about robotics)
No. In the hands of a skilled laparoscopic surgeon, the Robot does not offer any advantages over laparoscopic surgery. The claims that the robot is better at doing surgery in patients who are obese or have severe adhesions are untrue. The reason some Gynecologic surgeons choose to use the robot is because they do not have enough training and skill to perform the surgery laparoscopically. The company that manufactures the robot, Intuitive Surgical, Inc, specifically targets surgeons who have very limited laparoscopic abilities. The robot is the alternative to open surgery for a doctor who is not proficient in laparoscopy. Unfortunately, many doctors continue to offer robotic surgery as the “best option” despite numerous studies indicating that robotic surgery has no benefit in treating gynecologic conditions.
There are several disadvantages to robotic surgery: more incisions and bigger incision size, all in a much more visible location. The greater the size and number of the incisions, the more pain you’ll have and the longer the recovery. It is especially devastating for patients prone to keloids (thick skin scars) to have 5 scars across the middle of the abdomen after a robotic surgery. Robotic surgery is usually much longer than laparoscopic surgery putting patient at higher risks for complications from general anesthesia, especially those with heart and lung problems. Robotic surgery also puts a tremendous burden on healthcare costs because of the astronomical cost of the equipment and the time needed to perform each surgery.