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| LAPAROSCOPIC SUPRACERVICAL HYSTERECTOMY | ||||||
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Hysterectomy is a surgical procedure to remove the uterus. It is most often performed for uterine fibroids (non-cancerous tumors), endometriosis (cells from the lining of the uterus growing on other organs), or uterine prolapse (falling of the uterus into the vagina). Hysterectomy is the second most common surgical procedure performed on reproductive age women in the U.S. In recent years, there has been concern that hysterectomies were being performed more often than needed. We share this concern, and prefer to use non-surgical methods for managing most pelvic disorders. However, for some women, the problem cannot be adequately managed with more conservative measures or it becomes prolonged or severe enough to warrant the "definitive" procedure, a hysterectomy. Two thirds of all hysterectomies in the U.S. are still performed using the traditional method known as "total abdominal hysterectomy". This procedure entails making a 6 to 10 inch skin incision on the belly and cutting through and separating the layers of the abdomen to remove the uterus. Total abdominal hysterectomy usually requires a 2 to 3 day hospital stay and 6 weeks of recovery. While on faculty at the University of Washington in Seattle and Emory University in Atlanta, Dr. Lepine obtained extensive experience in "vaginal hysterectomies". With this approach, the uterus is removed through the vagina, avoiding an abdominal incision. Hospital stay is usually only 1 day and most patients recover well in 3 to 4 weeks. Through further experience at the Atlanta Minimally Invasive Surgery Center, Dr. Lepine expanded her surgical repertoire to include "laparoscopic supracervical hysterectomy (LSH)". LSH is the least invasive method of hysterectomy, and is our preferred approach. During an LSH, a laparoscope (a slender tube with a camera at the end) is used to visualize the abdomen and pelvis. The uterus is separated and removed through two to three tiny skin incisions. An LSH can be performed even in a patient with a large uterus because the uterine tissue is "morcellated" or cut into thin strips before it is removed. With an LSH, the cervix is left in place. However, women can choose to have their tubes and ovaries left in place or removed, depending on their age, hormonal status, and personal preference. LSH results in less blood loss and post-operative pain, and has better cosmetic results and a more rapid recovery rate than other methods of hysterectomy. Leaving the cervix in place permits return to sexual activity in 1 to 2 weeks. Most women also return to their usual activities —including work and sports— within just a few weeks. Patients are generally discharged the day of surgery, but can choose to stay overnight in the hospital if desired. Women who have an abnormal Pap smear or who choose to have their cervix removed can still have the benefits of laparoscopic surgery for their "total hysterectomy". Dr. Lepine performs laparoscopic total hysterectomies using the da Vinci® robot. In some cases, she will also use the da Vinci® robot to perform an LSH. For more information on hysterectomy, LSH, and the da Vinci® robot, see Resources. |
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