Hysterectomy by keyhole that spares a woman’s love life

IT’S an invasive operation that can rob women of their sex life. But a new keyhole procedure for hysterectomy means many may still be able to enjoy intimacy – as it keeps more of the delicate female anatomy intact. The technique, being carried out in two NHS hospitals, involves encasing the womb in a bag before it is removed. This minimises damage to surrounding tissue, which can lead to long-term problems with intercourse and incontinence.

The procedure slashes the risk of post-surgical complications to just two per cent, compared with up to 60 per cent in some conventional techniques.

Each year more than 55,000 British women have a hysterectomy – involving complete removal of the womb, and sometimes the ovaries, fallopian tubes and the cervix, the muscular ring at the womb’s entrance. Reasons include heavy monthly bleeding, pelvic pain, cancers of the pelvic area, thickening of the womb lining – known as endometriosis – and non-cancerous growths on the womb, called fibroids.

Commonly, the procedure is completed via a large cut into the stomach during major, open surgery. It involves a week-long hospital stay with women unable to drive, walk long distances, exercise or have sex for months. Infections and damage to blood vessels are common due to disturbance to surrounding delicate organs such as the bowel and bladder.

Many women now opt for keyhole procedures at specialist hospitals, which involve a smaller scar and much shorter recovery times. But even these operations, in which the womb is broken into small pieces and removed through a tiny incision in the abdomen, carry significant risks, including damage to healthy pelvic tissue, and the spread of undiagnosed cancers. Last week an Australian study reported that women suffering from cervical cancer who had keyhole hysterectomies had a ten-fold increased risk of recurrence compared to those who had open surgery.

The new procedure has all the benefits of keyhole surgery, including a lower rate of infection and faster recovery time, but without these risks.

It involves the womb being contained inside a surgical bag – which is inflated around it in the abdomen. The organ is then cut into small pieces. The bag is deflated and removed through an incision in the abdomen less than an inch long – a tenth of the size of the incision in an open hysterectomy.

The procedure is called in-bag morcellation, and has primarily been offered to NHS patients needing a hysterectomy due to troublesome fibroids – growths that cause severe bleeding and pain. It is also available to women with endometriosis.

As fibroids look similar to cancerous tumours, misdiagnosis is common with surgeons only discovering that the presumed fibroid is in fact a tumour after the operation. Surgeons extract the growths in their entirety to prevent unintentional spread of undiagnosed cancer.

Dr Banchhita Sahu, consultant obstetrician and gynaecologist, says in-bag morcellation is the only technique that slashes the risk of the fibroids returning. ‘There is a high rate of recurrence with most procedures,’ explains Dr Sahu, who carries out the new operation at Telford’s Princess Royal Hospital.

During the 90-minute procedure, with patients under general anaesthetic, Dr Sahu makes three incisions in the lower abdomen. A miniature camera is inserted into the first with images beamed to a screen to guide the operation.

Through a second incision, tiny instruments detach the womb from the cervix by burning through the connecting tissue.

A third, slightly bigger incision makes room for a slim tube, or port, through which the nylon bag is threaded. The bag is positioned to encase the uterus and any attached growths.

Air is then injected through the port, inflating the bag to six inches in diameter. This pushes the organs and cervix away, protecting them while the womb is broken apart.

The bag is pulled closed using a drawstring, deflated, threaded through the port and removed via the stomach. The wounds are stitched and patients can return home within six hours. ‘We barely touch the other organs,’ says Dr Sahu. ‘Pain is minimal and patients can drive, walk and have sex again within two to four weeks.’

Shirley Hughes, 43, a teaching assistant from Shropshire, had the procedure last year. ‘Within 48 hours I was barely in any pain at all,’ says the mother-of-two, ‘I was walking within a week. I’ve had no complications and I’m still able to enjoy regular sex. My partner hasn’t noticed the difference!’

Dr Sahu says: ‘It allows women to carry on with their lives. We hope to offer this for all hysterectomy operations very soon.’