FOCUS: HYSTERECTOMY
Definition
Types of Hysterectomy
Reasons for Hysterectomy
Surgical Options
Advantages/Disadvantages
Questions & Answers
WHAT IS A HYSTERECTOMY?
HYSTERECTOMY:THE SURGICAL REMOVAL OF THE UTERUS
HYSTERECTOMY FACTS
Second most commonly performed gynecologicprocedure in the U.S., after Cesarian Section
1 in 3 women will have a hysterectomyby age 60
Over 65% of hysterectomies are stillperformed through an abdominal incision ( TAH )
Over 600,000 hysterectomies are performed annually in the U.S.
ARE THERE DIFFERENTTYPES OF HYSTERECTOMY?
HYSTERECTOMY TYPES
Total Hysterectomy
Radical Hysterectomy
Subtotal Hysterectomy3
TOTAL HYSTERECTOMY:SURGICAL REMOVAL OF THE UTERUS & CERVIX
SUBTOTAL HYSTERECTOMY:
SURGICAL REMOVAL OF THE UTERUSLEAVING THE CERVIX IN PLACE
RADICAL HYSTERECTOMY:
SURGICAL REMOVAL OF THE UTERUS,CERVIX,AND PELVIC LYMPH NODES. OTHER TISSUEINCLUDING OVARIES, FALLOPIAN TUBES, AND SOME OF THE VAGINA MAY BE REMOVED.
OOPHORECTOMY:
SURGICAL REMOVAL OF AN OVARY
BILATERAL SALPINGO OOPHORECTOMY:SURGICAL REMOVAL OF BOTH OVARIES AND FALLOPIAN TUBES
WHY HAS YOUR DOCTORRECOMMENDED HYSTERECTOMY?
INDICATIONS FOR HYSTERECTOMY
FibroidsEndometriosisProlapseCancerAdhesionsSevere Pelvic PainAbnormal Bleeding
HOW WILL MY DOCTORPERFORM THE HYSTERECTOMY?
HYSTERECTOMY OPTIONS3Total Abdominal Hysterectomy ( TAH )
Laparoscopic Hysterectomy ( LH )
Vaginal Hysterectomy ( VH )
TAH
TOTAL ABDOMINAL HYSTERECTOMY
Open Surgery
Over 65% of all hysterectomies
The most common approachto hysterectomy
Performed through a 4-8 inch incision in the abdominal wall
VH
VAGINAL HYSTERECTOMY
Performed through the vagina
Over 20% of all hysterectomies
Second most common approachto hysterectomy
No abdominal incisions
WHAT IS LAPAROSCOPIC SURGERY?
LAPAROSCOPIC SURGERY
Minimally Invasive Surgery ( MIS )
Laparoscopic instruments are theninserted into the ports
Laparoscope used to see inside of abdomen
“LAPARO” = ABDOMEN
Special tubes called “ports” are inserted Into tiny incisions in the abdomen
LH
LAPAROSCOPIC HYSTERECTOMY
First LH perfomed in 1989
ONLY 10 -11% of all hysterectomies
Use a Laparoscope to see inside of abdomen
Newest approach to hysterectomy
Laparoscopic instruments are insertedInto 3-4 half inch incisions in abdomen
LAPAROSCOPIC HYSTERECTOMY
LAVH Laparoscopically Assisted Vaginal Hysterectomy
Robotic Hysterectomy ( da Vinci )
TLHTotal Laparoscopic Hysterectomy
LSHLaparoscopic Supracervical Hysterectomy
LAVHLaparoscopically Assisted Vaginal Hysterectomy
Technique involves initially performing a laparoscopic surgery
Initially bridged the gap between the needfor Abdominal – Vaginal Hysterectomy
Uterus is removed through the vagina
Uterus is detached using laparoscopicinstruments
LSHLaparoscopic Supracervical Hysterectomy
Technique involves detaching the uteruswith or without the ovaries using laparoscopicinstruments
Instrument called a morcellator allows the tissue to be cut into pieces then removedthrough the abdominal ports
Leaves a portion of the cervix behind
Uterus is then released or amputated fromcervix
TLHTotal Laparoscopic Hysterectomy
Developed as a substitute for TAH
Uterus may be removed through the Laparoscopic incision at the top of the vagina
Uterus may be removed in pieces throughthe morcellator
Removes entire uterus along with cervix,with or without ovaries laparoscopically
Incision is then closed laparoscopically
da VinciRobotic Hysterectomy
Involves a 3D approach to laparoscopic surgery
Allows for increased dexterity and 3D vision
Surgeon operates at an ergonomic consoleequipped with 3D vision and control of wristedinstruments
da Vinci system was approved in 1995
da VinciRobotic Hysterectomy
?WHAT ARE THE ADVANTAGES & DISADVANTAGES
OF TAH, VH, & LH
TOTAL ABDOMINAL HYSTERECTOMY
Easy to see pelvic organs
Surgeon’s have the most experiencewith this kind of hysterectomy
Performed even with adhesions
Removal of any sized uterus
ADVANTAGES
TOTAL ABDOMINAL HYSTERECTOMY DISADVANTAGESLarge abdominal scarMore pain is reportedIncreased adhesionsIncreased risk of post-operative complicationsLonger hospital stayProlonged recoveryMore expensive than Vaginal Hysterectomy
ADVANTAGESVAGINAL HYSTERECTOMY
Less post-operative pain
May be preferable to TAH for obese woman
No visible scar
Less intra-operative & post-operative complications
ADVANTAGESVAGINAL HYSTERECTOMY
Shorter operating time
Less cost
Faster recovery time
Shorter hospitalization
DISADVANTAGESVAGINAL HYSTERECTOMY
Limited visualization of uterus & pelvic organs
Diagnosis & treatment of disease is restricted
Difficult to remove large fibroids
Difficult to perform an Oophorectomy
Women with a large uterus, severe endometriosis,adhesions, or nulliparous may not be candidates
Less experienced surgeons may not be comfortable
ADVANTAGESLAPAROSCOPIC HYSTERECTOMY
Magnification of anatomy & pathology
Less adhesion formation
Less blood loss
Minimal tissue trauma
ADVANTAGESLAPAROSCOPIC HYSTERECTOMY
Small incisions
Shorter hospital stay
Less painful
Less chance of wound infection
Saved work hours
Quicker recovery
DISADVANTAGESLAPAROSCOPIC HYSTERECTOMY
Longer operating time
More expensive
Few surgeons have experience & training
Demands new skills for staff
Difficult with large fibroids
?WHAT DOES THE FUTURE HOLD
FUTURE OF GYNECOLOGY
Office micro-laparoscopy or mini-laparoscopy
Evaluation of infertility
Perform office biopsies and sterilization
Uses for diagnosis of emergency room patient
Evaluation of abdominal pain
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