03 January 2007

A hysterectomy revolution?

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.

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 gynaecology at the University of Texas Southwestern Medical Centre 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.

Best to leave cervix?
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.

Too early to gauge risk
"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 gynaecology at Vanderbilt University Medical Centre in Nashville, Tennessee.

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 sceptics 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.

Not for everybody
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, gynaecology and surgery at the University of Texas Southwestern Medical Centre at Dallas.

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

Read more:
Understanding hysterectomy
Hysterectomy may dull desire

January 2007




Read Health24’s Comments Policy

Comment on this story
Comments have been closed for this article.

Live healthier

Mental health & your work »

How open are you about mental illness in the workplace?

Mental health in the workplace – what you can do to help

If you know that one of your colleagues suffers from a mental illness, would you be able to help them at work? Maligay Govender offers some helpful mental health "first aid" tips.

Sleep & You »

Sleep vs. no sleep Diagnosis of insomnia

6 things that are sabotaging your sleep

Kick these shut-eye killers to the kerb and make your whole life better – overnight.