A newer surgical procedure, laparoscopic supracervical hysterectomy, is a minimally invasive option for women undergoing a hysterectomy.
The procedure involves a surgeon carefully separating the uterus from the cervix and removing it through one of three tiny abdominal incisions. For patients, that means a quicker recovery time and less pain.
"With minimal incisions, we can remove the uterus through a half-inch in the abdomen," said David Billings, obstetrician/gynecologist for Trinity Health of Minot. "The patient can actually go home the same day. Pain is minimalized because of the smaller incisions. They're able to manage pain by taking Motrin or Aleve."
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Katina Tengesdal/MDN - - Dr. David Billings, obstetrician/gynecologist for Trinity Health of Minot, discussed how laparoscopic supracervical hysterectomy is less invasive than more traditional hysterectomies.
The procedure also leaves the cervix in place, which has some advantages for patients. Billings explained that research suggests leaving the cervix in place may help reduce the risk of prolapse or loss of pelvic support, a condition where the muscles and tissues supporting the pelvis weaken, causing the organs to fall from their normal position and in some cases even protrude into the vagina.
In addition, the surgery that leaves the cervix in place may have benefits in regard to urinary and sexual function.
Patients who undergo the procedure can often resume normal activity within two weeks, Billings said, in contrast to the four to six weeks it took to heal from transabdominal or abdominal hysterectomy.
Fact Box
Hysterectomies: When are they needed?
According to the United States Department of Health and Human Services, hysterectomy is the second most frequently performed surgery on women after Cesarean section. About a third of American women will have a hysterectomy by the time they are 60 years of age.
Women commonly choose hysterectomy because of difficult symptoms.
"Most of the reasons for it are abnormal bleeding, for women that no longer need the uterus for child-bearing. They may have pain, and sometimes cancers," Dr. David Billings said.
After a hysterectomy, the bleeding symptoms will immediately stop, and pain patients experienced before is greatly improved. In hysterectomy procedures, if the ovaries are left in place, women have no changes in their hormonal balance.
Some patients, however, also opt to have their ovaries removed during the procedure as well. Those who choose that option are often those who are already past the age of menopause, or those who have had ovarian cysts.
"(Traditional hysterectomies) can take six weeks to heal," he said. "Not only the scar, but we have to open the abdominal muscles and tissue down to the uterus, and the incision is 6 to 8 inches in length."
Patients returning for followup visits have reported being happy with the procedure, especially those who have had previous Cesarean sections, because healing time and pain are reduced.
Billings began doing the new procedure at Trinity Health in 1999, but since then, newer equipment added within the past year has meant that the procedure is more widely practiced. Now, other providers at Trinity Health are performing the surgery as well.
"The technology has increased so much over the years, that it's easier for a surgery," Billings said.
"Around 10 years ago, we had similar equipment, but it was larger, bulky, and it would dull faster," he said. "The instruments now are sharper, they are disposable, it decreases bleeding during the procedure and it's much faster to do it now."
Patients are more apt to ask for the surgery in recent years, he said, as it becomes more expected and more widely understood. Some patients will even come in and ask for the procedure by name.
While traditional hysterectomy is still indicated for some patients -- some patients require bigger incisions because of adhesions or scar tissue that can't be removed laparoscopically -- the revised procedure accounts for about three-quarters of the hysterectomies Billings performs.
Procedure
During the procedure, small surgical instruments and a laparoscope are used. A laparoscope is a thin tube with a light source and a tiny camera at the end of it. The instruments and the laparoscope are inserted through tiny incisions in the navel and abdomen.
The surgeon manipulates the instruments to perform surgery internally while viewing the procedure on a view screen. The uterus is carefully separated from the cervix and removed through one of the incisions.
The procedure can be performed on an inpatient or outpatient basis under general or regional anesthesia, which allows patients to return home within 24 hours.