DETAILS BEHIND THE HYSTERECTOMY

BE INFORMED AND KNOW ALL THE FACTS

Many women are faced with the need to undergo a hysterectomy. The procedure removes the uterus (womb) and in some cases the cervix, ovaries, and fallopian tubes, to surgically treat conditions such as fibroids, endometriosis, uterine prolapse, gynaecologic cancer and chronic pelvic pain.

A total abdominal hysterectomy was once the standard surgical approach, but now, for benign conditions, less invasive techniques such as vaginal hysterectomy and laparoscopic hysterectomy, have been found to produce better outcomes and fewer complications than other options.

But what are these different surgical approaches and what is the difference between them?

VAGINAL HYSTERECTOMY

A vaginal hysterectomy is performed through a small incision at the top of the vagina through which the uterus (and cervix, if necessary) is removed. This approach does not require an incision in the abdomen and is therefore often referred to as a “no (visible abdominal) incision” hysterectomy.

LAPAROSCOPIC HYSTERECTOMY

In a laparoscopic hysterectomy, special surgical tools are used to operate through small incisions in the abdomen and vagina.

There are two types of laparoscopic hysterectomy — a laparoscopically-assisted vaginal hysterectomy and a laparoscopic supracervical hysterectomy.

A laparoscopically-assisted vaginal hysterectomy is similar to a vaginal hysterectomy, however the surgeon also uses a laparoscope (miniature camera) inserted into the abdomen to see the uterus and surrounding organs. Other laparoscopic tools are used to detach the uterus before removing it.

A laparoscopic supracervical hysterectomy is performed entirely through small abdominal incisions using laparoscopic tools to remove the uterus. No incision is made at the top of the vagina but several small incisions are made in the abdomen.

An extensive review of the medical literature indicates that a vaginal hysterectomy is the safest and most cost-effective procedure for removal of the uterus as it is statistically significantly associated with improved outcomes such as a shorter length of hospital stay, faster return to normal activity and less post-operative morbidity than both a total abdominal hysterectomy and laparoscopic hysterectomy.

Laparoscopic hysterectomy is the second least invasive and costly option for patients, with benign conditions, as it has several advantages over abdominal hysterectomy such as producing less pain, faster recovery times and less scarring.

The surgical approach to hysterectomy should be decided by the woman in discussion with her surgeon.

This discussion should cover the relative benefits and hazards. Before making a decision, she also needs to take into consideration the experience of her surgeon and the number of successful procedures they have performed, as these factors also have the potential to influence the outcomes.