Tuesday, January 02, 2007

Laparoscopic Hysterectomy: A New Approach

(HealthDay News) -- With incisions no bigger than keyholes, a woman can undergo a hysterectomy, go home the same day, and be back at her desk within two weeks.

Doctors say that as technology improves, and they become more familiar with the techniques, they are performing laparoscopic hysterectomies more often, usually at the behest of women who want to be back on their feet in a hurry.

Some women may have postponed the procedure for years, enduring pain or bleeding, because they couldn't afford the usual recovery time.

"One of my patients was self-employed and couldn't take the six weeks off," said Dr. Mayra Thompson, associate professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center at Dallas. "She said, 'I'll lose my business and my home, and I can't do it.' "

Thompson ultimately operated laparoscopically, inserting a scope to view the internal site and using long-handled instruments to peel away the uterus. The patient was back at work in 10 days, said Thompson. "How can you beat that? Otherwise, she would have been really out of luck," she said.

Thompson is among those physicians who think it's best to perform a procedure known as a "supracervical" hysterectomy, leaving the cervix -- the narrow outer end of uterus -- intact in women who do not have irregular Pap smears or other complications.

The thought is that leaving the cervix will protect vaginal supports and help prevent prolapse, a condition that occurs over time when the bladder or rectum is pulled downward. This kind of surgery also eases the worries of some women who think removing the cervix will interfere with their sex lives, though studies have shown there is usually no physical change to prevent normal sexual pleasure after healing, doctors said.

Other doctors prefer to perform vaginal hysterectomies, which also have a faster recovery time than "open" surgery.

"I still think vaginal is the preferred way to go if the patient is OK with having the cervix out," said Dr. Howard T. Sharp, associate professor and chief of the General Division of Obstetrics and Gynecology at the University of Utah School of Medicine in Salt Lake City. "Up to a third of women who have a subtotal hysterectomy (removing the uterus only) will end up having the cervix removed at a later time because of bleeding or prolapse."

Others are reserving judgment in what has become a hotly debated subject.

"I can tell you there is not a lot of science for either side of that coin. It's too early. We don't know whether removing the cervix reduces the risk of prolapse or not," said Dr. Barry Jarnagin, associate professor of gynecology at Vanderbilt University Medical Center in Nashville, Tenn.
Given a choice, he prefers to leave the cervix because there is less disruption to the pelvic floor, which is less painful to the patient and beneficial in prolapse and other surgery that may become necessary later on.

Regardless of the extent of the organ removal, however, some doctors prefer the laparoscopic technique because the scopes used in the surgery make it possible to view places in the body they have trouble seeing with the standard "open" surgery technique, Thompson said.

And, while skeptics once complained that minimally invasive surgery actually took longer, it can be a far shorter procedure for surgeons with up-to-date equipment and lots of experience, she said.

But the surgery isn't for everybody, the doctors said. And, not all patients can go back to work immediately, particularly if their jobs are physically straining.

"It is still major surgery, and everybody heals differently," said Dr. Karen Bradshaw, professor of obstetrics, gynecology and surgery at the University of Texas Southwestern Medical Center at Dallas.

But, for patients who are good candidates, it's a fine alternative to traditional surgery, she said. "Patients recover so much faster."

More information
For more on hysterectomies, visit the U.S. National Women's Health Information Center.

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