It's estimated that more than 600,000 women each year undergo a hysterectomy for a variety of reasons. The surgery may be limited to the uterus, but may also include cervix and/or ovaries removal.
The most common form of this surgery, the abdominal hysterectomy involves a 6- to 8-inch horizontal incision below the belly button, performed under general anesthesia. Hospital stay is usually five or six days with six weeks recovery time. The vaginal hysterectomy, using a smaller incision inside the vagina, requires a shorter hospital stay -- up to three days -- and four weeks recovery time. It also leaves no external scar.
Newer surgeries are less invasive, leave no scars and require a shorter recovery period. The laparoscopic hysterectomy uses a thin, lighted telescope-like instrument with a camera that's inserted into three to five tiny incisions in the navel, while the laparoscopic-assisted vaginal procedure begins with navel incisions and is completed through the vagina.
The robotic hysterectomy is a computer-enhanced method in which robotic instruments are inserted through four or five small incisions in the abdomen. The surgical area is magnified in 3-D on a video screen, with the physician manipulating remote controls.
"Hysterectomy remains a significant surgery, but technology has made major improvements that benefit of our patients," says Elizabeth Howell, an ob-gyn physician at McKee Medical Center.
"We've had many changes -- from abdominal, to vaginal, laparoscopic and robotic. It's a tremendous improvement."
The robotic system offers magnification and finer control, allowing the surgeon more precision. It also has more flexibility, says Howell. "There's no need to use larger instruments, even though the incision is smaller. The articulating instruments allow for bending and getting all of the necessary angles. In comparison, other instruments are almost like chopsticks -- straight. There's less pain, better healing. It's a tremendous jump."
Howell says there's still a six-week recovery, even with advanced technology. "But after two weeks, we find that patients feel so good we have to remind them to behave and take it easy."
A hysterectomy may be the answer for a variety of conditions, including pelvic pain, excessive bleeding, cramping, endometriosis or someone with precancerous cells that may be mostly benign. Surgery may not be the initial decision in many cases, according to Howell.
"Often, we can decide to do nothing and monitor the situation for any change. We may manage it with medication such as birth control pills or an IUD to thin out the lining of the uterus," she says. "In other cases, we may do an outpatient ablation, in which the lining of the uterus is burned away to make your periods lighter."
These improved techniques offer women more options regarding their health and lifestyle. "As these surgeries become available, we can tailor the hysterectomy a lot more to a woman's individual needs," says Howell. "It's has also opened up our approach to conversations with our patients. We've come from a point where the doctor dictated the procedure to having the patient examine options and make choices."
Many times, decisions are based around a history of difficult periods. "As a woman, you look at having that period every month and it has a tremendous effect," says Howell. "It's a big chunk out of your life -- one-quarter of your adult life, a week or more every month."
Options also allow a woman to decide when and why she might want a hysterectomy prior to onset of any medical problems. Reasons might vary from the decision not to have children, to stopping periods prior to menopause.
"We can offer options you don't have to feel bad about," she says, "This is about making the best decision for your personal needs. Every woman is different; it's not all black or white. Our patients should have the best information and choices based on medical history, family history and lifestyle."
The advancements are a win for patient and physician. "We're in a really good place in medicine today," Howell notes. "As physicians, we're learning more and our patients are becoming more educated. It's a good partnership -- a very satisfying field today compared to back in the day."