By Mel Kurtulus, M.D., Scripps Memorial Hospital La Jolla
Just a few years ago, a hysterectomy meant several hours of abdominal surgery, three or four days spent in the hospital, and a recovery period likely to last six to eight weeks. In the last decade, however, a new alternative to traditional abdominal hysterectomy has become available: laparoscopic hysterectomy. Performed using minimally invasive laparoscopic surgical techniques, this procedure reduces the length of surgery, hospital stay, and recovery time—as well as pain and complications—and represents a major advancement in women’s health care.
Laparoscopic hysterectomy uses several thin instruments and a video camera attached to a telescope to remove the uterus. Unlike the older procedure, there are no incisions made in the abdomen or vagina. An incision of about one-half inch is made in the bellybutton, and the camera and instruments are inserted through the incision. The camera transmits an image of the internal organs onto a television monitor, and the surgeon uses the image to guide him or her through the process of detaching the uterus and removing it through the same incision at the bellybutton.
This minimally invasive procedure offers many advantages to women over a traditional abdominal hysterectomy. Instead of several hours of surgery and an extended hospital stay, laparoscopic surgery can be performed on an outpatient basis; in most cases, the procedure itself takes less than an hour, and patients can go home the same day. There is very little to no blood loss, and minimal risk for complications. Pain is minimal—patients generally can use a non-narcotic pain reliever if one is needed, as opposed to the IV morphine or other prescription painkillers often given to patients who have traditional hysterectomy. All of these factors lead to a faster recovery time as well; most lap patients can return to work in seven to ten days. Because the incision is minimal, so is scarring.
Yet despite the many advantages of laparoscopic hysterectomy in contrast to an abdominal procedure, only about 15 percent of hysterectomies are currently performed laparoscopically. One reason for this is that relatively few physicians are trained specifically to perform the procedure; as a result, a woman whose physician does not offer laparoscopic hysterectomy may not even be aware that an alternative to abdominal surgery is available. If your physician recommends a hysterectomy and does not discuss the laparoscopic option with you, feel free to ask about it or ask for a referral to a surgeon specially trained in laparoscopic hysterectomy.
In some cases, surgeons may begin the procedure using minimally invasive techniques, then discover once they have begun that scar tissue or other challenges mandate a traditional abdominal procedure. However, this is not common—except in cases of severe endometriosis or severe scarring, most women are candidates for laparoscopy. Even then, a trained laparoscopic surgeon can often remove the diseased tissue with the laparoscope before removing the uterus. Be sure to ask the surgeon about his or her conversion rate for hysterectomy; that is, how often he or she begins the procedure laparoscopically but finishes it with open abdominal surgery. Don’t hesitate to ask whether a surgeon has specialized training, such as a fellowship, in laparoscopic hysterectomy. The more specialized your surgeon, the lower the conversion rate is likely to be.
In addition to hysterectomy, laparoscopy is often an option for other gynecological procedures, including treatment of ovarian cysts, pelvic masses, fibroid tumors, endometriosis and incontinence.
Mel Kurtulus, M.D.,FACOG, is an OB/GYN with Scripps Memorial Hospital La Jolla. He completed a fellowship in laparoscopic & pelvic surgery at Stanford University Hospital. For more information on laparoscopic hysterectomy and other procedures, please call 1-800-SCRIPPS.