The Alegent Health Podcast #29 - Laparoscopic Hysterectomies
(Kelly) Every year doctors perform hundreds of thousands of hysterectomies on women across the U.S. Most of these surgeries are open – leaving patients with a large scar and a long recovery. Now many Alegent Health Clinic patients have another option – laparoscopic hysterectomy.
Women’s Health Specialist Dr. Ann Sullivan performs several each month. Dr. Sullivan – can you tell me what a laparoscopic hysterectomy is and how that’s different from, say, the one my mother and grandmother had?
(Dr. Sullivan) A traditional hysterectomy, the way we used to always do it, would be to make an incision on the abdomen – much like women have when they have a c-section. So you have a big incision; you usually spend two or three days in the hospital; recover is usually about 6 to 8 weeks before patients feel well enough to go back to work or to resume normal activities.
The alternative to that is also a vaginal hysterectomy or sometimes laparoscopically-assisted vaginal hysterectomies, which improves recovery time and the length of time a patient stays in the hospital. But still there’s a lot of discomfort from the vaginal portion of the procedure that requires some longer recovery, whereas a laparoscopic hysterectomy is done through usually 3 – sometimes 4 – small incisions on the abdomen, that are 5- 10 millimeters in size. And the whole surgery is done with a camera and laparoscopic instruments. And then the uterus is removed either in pieces or in its entirety through the vagina.
The advantage of doing it laparoscopically is the quicker recovery time. Most patients spend one night in the hospital. Occasionally they spend two, but some patients have gone home on the same day as the surgery. Usually I recommend to take a quicker recovery time and patients can go back to work a lot faster.
(Kelly) Who’s a candidate for this kind of surgery?
(Dr. Sullivan) Basically anybody who is a candidate for a hysterectomy. We used to always recommend that if you have a smaller uterus and you have good descentus, where the uterus would come down and it felt like it would descend easily through the vagina – then that would be a good candidate for a vaginal hysterectomy. But there are studies that are showing that laparoscopic hysterectomy may even be better for those people as the recovery is even shorter and better than it is for a vaginal hysterectomy.
(Kelly) If a woman has fibroids, is she a candidate for this kind of surgery as well?
(Dr. Sullivan) Absolutely. If they are really big fibroids, like the size of a 5-month pregnancy, sometimes that can be big enough to where we can’t do it with the camera just because we don’t have room to get the camera in there. But most people who have fibroids are not that big and it can be done through the camera. It may be where we actually remove the fibroid in the first part of this procedure and then go ahead and continue the hysterectomy so that we can see better for the rest of the procedure.
(Kelly) What if you had a c-section or a myomectomy – can you still qualify for laparoscopic hysterectomy?
(Dr. Sullivan) Sure – in a myomectomy there is no reason why you wouldn’t be able to have a laparoscopic hysterectomy. With a c-section – any kind of hysterectomy, there is a risk of having some type of injury to the bladder because sometimes there can be some scar tissue around the bladder, and it can be adhesed to the lower uterine segment in the cervix. But no matter how the hysterectomy is done, we always take care to know where the bladder is at and that it is dissected out of our operative field. There is always some risk there, but it is not a reason to not have a laparoscopic hysterectomy.
(Kelly) Now when you do the surgery – are you just removing the uterus or can you remove the ovaries as well, laparascopically?
(Dr. Sullivan) There’s a couple of different ways you can do it. One – you can just take the uterus and leave both the cervix and the ovaries. Some people will opt to leave their cervix behind. Most people will go ahead and have the cervix removed because there’s no real huge advantage to keeping your cervix. Then the ovaries can easily be taken or left behind – depending on if there is any issues with the ovaries and what the patient desires.
(Kelly) What kind of questions should a woman ask her doctor if they’re talking about a hysterectomy but the doctor doesn’t bring up a laparoscopic procedure?
(Dr. Sullivan) She should always ask what all of her options are. If there is a reason why it needs to be done a certain way. If they’re suggesting she have a traditional incision with a laparotomy- with the larger incision like when women have a c-section – if they’re suggesting that, she should ask if there is a reason why she can’t have it done either vaginally or laparoscopically - if there’s any advantages to having it done that way.
(Kelly) Though the recovery time is shorter, it is possible for a woman to push too hard, too fast following a laparoscopic hysterectomy. Dr. Sullivan encourages patients to take it easy. Still take at least two weeks off work – and use precaution when it comes to lifting for at least six more. She warns that even though you feel fine, you still have internal wounds that need time to heal.
Thank you for listening to this Alegent Health Podcast. I’m Kelly Grinnell.