DE­TAILS BE­HIND THE HYS­TEREC­TOMY

BE IN­FORMED AND KNOW ALL THE FACTS

Style Magazine - - Promotion - Health - — Ref­er­ences: The Amer­i­can Congress of Ob­stet­rics and Gy­nae­col­ogy & Dr Roseanne M Kho.

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.

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