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Understanding hysterectomy: 4 things you should know
Minimally-invasive approaches like robotic hysterectomy are improving outcomes for women
When it comes to surgical procedures, hysterectomy is one of the most common of them all — one in three American women has a hysterectomy by age 60. But that doesn’t mean women find the decision easy, says Melissa Nicosia, MD, director of obstetrics and gynecology at Mather Hospital.
“Many women aren’t aware of all of the options that are available if they need a hysterectomy,” she says. “And they’re often concerned that it may affect their quality of life or sexual health. But if other therapies haven’t helped with abnormally heavy bleeding, painful periods, fibroids or pelvic organ prolapse, studies show that hysterectomy can actually improve how women feel about themselves and even improve their sexual function.”
Sharing information about today’s approach to hysterectomy often makes patients more comfortable, Dr. Nicosia says. Here are four key facts about this common surgery.
What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus. This common procedure can be used to treat benign precancers and cancerous conditions, and symptoms such as bleeding or chronic pain. They may also be used to reduce the risk of developing cancer.
If you have not yet experienced menopause, your hysterectomy will end menstruation. You will also no longer be able to become pregnant because the uterus is where the fetus develops.
It's gentler and more precise
A couple of decades ago, hysterectomy always involved open surgery and many days in the hospital. These days, it can often be done with a minimally invasive approach, including a robotic-assisted da Vinci Surgical System.
That system provides a magnified, three-dimensional visualization of the surgical field, and its flexible surgical instruments enable surgeons far greater control. By reducing the size of the incisions in the abdomen, your surgeon will remove your uterus through small tube-shaped instruments.
In addition to robotic hysterectomy, there are several other minimally-invasive approaches:
- Laparoscopic-assisted vaginal hysterectomy (LAVH)—This minimally invasive option involves an incision deep inside the vagina and incisions in the abdomen. Using the tiny camera in the laparoscope as a guide, your surgeon will remove the uterus through your vagina. This may not be an option if your uterus is too large to be safely removed through the vagina.
- Total laparoscopic hysterectomy (TLH)—This minimally invasive procedure requires small incisions in the abdomen. Laparoscopic surgical tools are then inserted into the abdomen to remove the uterus. This method allows for a minimally invasive approach even if your uterus is too large to exit the vagina.
- Vaginal hysterectomy—This method involves the surgeon removing the uterus entirely through your vagina. It does not require any incisions, but cannot be done if your uterus is too large to be safely removed through the vagina.
- Single-incision hysterectomy—By making one incision in the belly button, your surgeon can remove your uterus through a single incision with special laparoscopic or robotic equipment. This method reduces pain and scarring.
In some cases, an open surgical method called abdominal hysterectomy may be necessary due to the size of the uterus, a high number of fibroids or cancer that has spread to other areas of the pelvic region.
Robotic hysterectomy is human-driven
“There’s a misconception that robotic surgery means that there is a robot performing the procedure, not a human. That’s not true,” says Dr. Nicosia. During robotic-assisted surgery, a surgeon guides instruments from a computer console; the instruments move like a human hand but with an even greater range of motion. That allows doctors to perform surgery more quickly and more safely, she says.
“We can do the procedure with fewer and smaller incisions, so there’s a decreased risk of bleeding as well as a lower risk of infection. The system also offers a quicker recovery. Most patients can go home the same day.”
Types of hysterectomy
The type of hysterectomy you have depends on your condition and preferences. For instance, your OB/GYN may recommend a total hysterectomy, in which the uterus and the cervix are removed; this procedure may also include removal of the fallopian tubes and ovaries, depending on your age and medical condition. This is the most common type of hysterectomy.
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In a partial hysterectomy, the uterus is removed but the cervix is preserved. The best approach — vaginal, laparoscopic, robotic-assisted or traditional abdominal — is determined on a case-by-case basis in consultation with your doctor. The goal is to relieve symptoms so you can get back to your life as quickly as possible.
“It’s important that patients are aware of all their options,” Dr. Nicosia says. “My job as a physician is to give them all the information, with as little bias as possible, so that they are empowered to make an informed decision for themselves.”
Your specialist will make a recommendation on which type of hysterectomy is the safest option for you. Northwell Health’s Division of Minimally Invasive and Robotic Gynecologic Surgery has surgeons with expertise in the latest minimally invasive techniques, including robotic and single-incision surgery. Several of its hospitals have been designated as a Center of Excellence in Minimally Invasive Gynecologic Surgery (COEMIG) by the American Association of Gynecologic Laparoscopists and the Surgical Review Corporation.
To schedule a consultation with Dr. Nicosia, call 631-364-7916.
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