FOCUS: HYSTERECTOMY

Definition

Types of Hysterectomy

Reasons for Hysterectomy

Surgical Options

Advantages/Disadvantages

Questions & Answers

WHAT IS A HYSTERECTOMY?

HYSTERECTOMY:THE SURGICAL REMOVAL OF THE UTERUS

HYSTERECTOMY FACTS

Second most commonly performed gynecologicprocedure in the U.S., after Cesarian Section

1 in 3 women will have a hysterectomyby age 60

Over 65% of hysterectomies are stillperformed through an abdominal incision ( TAH )

Over 600,000 hysterectomies are performed annually in the U.S.

ARE THERE DIFFERENTTYPES OF HYSTERECTOMY?

HYSTERECTOMY TYPES

Total Hysterectomy

Radical Hysterectomy

Subtotal Hysterectomy3

TOTAL HYSTERECTOMY:SURGICAL REMOVAL OF THE UTERUS & CERVIX

SUBTOTAL HYSTERECTOMY:

SURGICAL REMOVAL OF THE UTERUSLEAVING THE CERVIX IN PLACE

RADICAL HYSTERECTOMY:

SURGICAL REMOVAL OF THE UTERUS,CERVIX,AND PELVIC LYMPH NODES. OTHER TISSUEINCLUDING OVARIES, FALLOPIAN TUBES, AND SOME OF THE VAGINA MAY BE REMOVED.

OOPHORECTOMY:

SURGICAL REMOVAL OF AN OVARY

BILATERAL SALPINGO OOPHORECTOMY:SURGICAL REMOVAL OF BOTH OVARIES AND FALLOPIAN TUBES

WHY HAS YOUR DOCTORRECOMMENDED HYSTERECTOMY?

INDICATIONS FOR HYSTERECTOMY

FibroidsEndometriosisProlapseCancerAdhesionsSevere Pelvic PainAbnormal Bleeding

HOW WILL MY DOCTORPERFORM THE HYSTERECTOMY?

HYSTERECTOMY OPTIONS3Total Abdominal Hysterectomy ( TAH )

Laparoscopic Hysterectomy ( LH )

Vaginal Hysterectomy ( VH )

TAH

TOTAL ABDOMINAL HYSTERECTOMY

Open Surgery

Over 65% of all hysterectomies

The most common approachto hysterectomy

Performed through a 4-8 inch incision in the abdominal wall

VH

VAGINAL HYSTERECTOMY

Performed through the vagina

Over 20% of all hysterectomies

Second most common approachto hysterectomy

No abdominal incisions

WHAT IS LAPAROSCOPIC SURGERY?

LAPAROSCOPIC SURGERY

Minimally Invasive Surgery ( MIS )

Laparoscopic instruments are theninserted into the ports

Laparoscope used to see inside of abdomen

“LAPARO” = ABDOMEN

Special tubes called “ports” are inserted Into tiny incisions in the abdomen

LH

LAPAROSCOPIC HYSTERECTOMY

First LH perfomed in 1989

ONLY 10 -11% of all hysterectomies

Use a Laparoscope to see inside of abdomen

Newest approach to hysterectomy

Laparoscopic instruments are insertedInto 3-4 half inch incisions in abdomen

LAPAROSCOPIC HYSTERECTOMY

LAVH Laparoscopically Assisted Vaginal Hysterectomy

Robotic Hysterectomy ( da Vinci )

TLHTotal Laparoscopic Hysterectomy

LSHLaparoscopic Supracervical Hysterectomy

LAVHLaparoscopically Assisted Vaginal Hysterectomy

Technique involves initially performing a laparoscopic surgery

Initially bridged the gap between the needfor Abdominal – Vaginal Hysterectomy

Uterus is removed through the vagina

Uterus is detached using laparoscopicinstruments

LSHLaparoscopic Supracervical Hysterectomy

Technique involves detaching the uteruswith or without the ovaries using laparoscopicinstruments

Instrument called a morcellator allows the tissue to be cut into pieces then removedthrough the abdominal ports

Leaves a portion of the cervix behind

Uterus is then released or amputated fromcervix

TLHTotal Laparoscopic Hysterectomy

Developed as a substitute for TAH

Uterus may be removed through the Laparoscopic incision at the top of the vagina

Uterus may be removed in pieces throughthe morcellator

Removes entire uterus along with cervix,with or without ovaries laparoscopically

Incision is then closed laparoscopically

da VinciRobotic Hysterectomy

Involves a 3D approach to laparoscopic surgery

Allows for increased dexterity and 3D vision

Surgeon operates at an ergonomic consoleequipped with 3D vision and control of wristedinstruments

da Vinci system was approved in 1995

da VinciRobotic Hysterectomy

?WHAT ARE THE ADVANTAGES & DISADVANTAGES

OF TAH, VH, & LH

TOTAL ABDOMINAL HYSTERECTOMY

Easy to see pelvic organs

Surgeon’s have the most experiencewith this kind of hysterectomy

Performed even with adhesions

Removal of any sized uterus

ADVANTAGES

TOTAL ABDOMINAL HYSTERECTOMY DISADVANTAGESLarge abdominal scarMore pain is reportedIncreased adhesionsIncreased risk of post-operative complicationsLonger hospital stayProlonged recoveryMore expensive than Vaginal Hysterectomy

ADVANTAGESVAGINAL HYSTERECTOMY

Less post-operative pain

May be preferable to TAH for obese woman

No visible scar

Less intra-operative & post-operative complications

ADVANTAGESVAGINAL HYSTERECTOMY

Shorter operating time

Less cost

Faster recovery time

Shorter hospitalization

DISADVANTAGESVAGINAL HYSTERECTOMY

Limited visualization of uterus & pelvic organs

Diagnosis & treatment of disease is restricted

Difficult to remove large fibroids

Difficult to perform an Oophorectomy

Women with a large uterus, severe endometriosis,adhesions, or nulliparous may not be candidates

Less experienced surgeons may not be comfortable

ADVANTAGESLAPAROSCOPIC HYSTERECTOMY

Magnification of anatomy & pathology

Less adhesion formation

Less blood loss

Minimal tissue trauma

ADVANTAGESLAPAROSCOPIC HYSTERECTOMY

Small incisions

Shorter hospital stay

Less painful

Less chance of wound infection

Saved work hours

Quicker recovery

DISADVANTAGESLAPAROSCOPIC HYSTERECTOMY

Longer operating time

More expensive

Few surgeons have experience & training

Demands new skills for staff

Difficult with large fibroids

?WHAT DOES THE FUTURE HOLD

FUTURE OF GYNECOLOGY

Office micro-laparoscopy or mini-laparoscopy

Evaluation of infertility

Perform office biopsies and sterilization

Uses for diagnosis of emergency room patient

Evaluation of abdominal pain