Q: I’ve recently found out that I need to undergo a hysterectomy—what are my options, and are there available procedures that offer less pain and recovery time?
A: Hysterectomy is the most common surgical procedure in the country after cesarean section. There are approximately 600,000 done each year in the United States. These are primarily done for benign disease, rather than cancer. Benign diseases for which a hysterectomy is frequently done are:
- Fibroids
- Abnormal bleeding
- Endometriosis
- Ovarian cysts or tumors
- Pre-cancerous conditions of the uterus or cervix
- Pelvic prolapse and incontinence
- Severe pelvic pain
Obviously, this is done in women finished with childbearing. The uterus and cervix is typically removed and the tubes and ovaries may also be removed. If the tubes and ovaries are removed in a pre-menopausal woman, she may require estrogen treatment after surgery.
If you have been told you need a hysterectomy, the first decision is whether or not to keep your ovaries. This will vary based on your age and any problems with prolapse symptoms or incontinence before surgery which may be repaired at the same surgical procedure.
Once you and your doctor have decided on the procedure or procedures to be done, the approach to the operation can be decided on. The options are having an abdominal, vaginal or laparoscopic (with or without the da Vinci ® Surgical System ) approach.
The vaginal approach is for a smaller uterus with prolapse which allows visualization from the vagina. The recovery is quick but the vaginal pain is more than for some of the other procedures. The abdominal approach allows us to see and access all your female as well as abdominal organs. For a complicated case, this has been the traditional approach. However, recovery is 4 to 6 weeks with a significant amount of abdominal and incisional pain – not exactly enjoyable.
The newer laparoscopic approach allows the visualization and access of an abdominal surgery however, because a telescope is used, the incisions are all only 1/4 inch. This allows for a quick recovery with less vaginal pain than a vaginal hysterectomy and certainly less than an abdominal hysterectomy but with the ability to do complex cases.
The da Vinci ® Surgical System takes this one step further, allowing even the most difficult abdominal cases to be done laparoscopically with the robotic aid. The 10 times magnification and 3-D view allows much better visualization than even the laparoscope alone, allowing difficult cases that would traditionally have been done with an abdominal incision. However, you have the minimal recovery with 1/4 inch incisions, less vaginal pain and return home in one day. You can return to normal activities in 7 to 10 days in most cases. Ask your doctor if you are a candidate. You'll be glad you did.
Sherri Levin, M.D. is a board-certified obstetrician/ gynecologist practicing in Houston, Texas. She established her practice at Memorial Hermann Memorial City in 1989.Dr. Levin was born in Fort Worth and graduated from Rice University, Cum Laude. She completed her residency at UT San Antonio and received her medical degree from the University of Texas Medical School, University of Texas Health Science Center, Houston, Texas. She is the host of Memorial Hermann Healthcare System’s radio talk show "The Houston Health Hour"
