Minimally invasive surgeries are an increasing trend in all surgical fields. In obstetrics and gynecology, this involves minimally invasive hysterectomies. Formerly there were two styles of hysterectomy, vaginal, which are considered minimally invasive, and abdominal. As surgical procedures with the laparoscope have advanced, so has the use of this tool during hysterectomy.
If, in the judgement of your doctor, a vaginal hysterectomy isn’t best for you; a transabdominal hysterectomy may be recommended. This requires a skin incision and 6-8 weeks of recovery time.
Dr. Blanton and Dr. Robertson have helped pioneer, evolve and employ new techniques and advances which allow for an ever-increasing percentage of “incisionless” hysterectomies to be performed. In fact, 75% of the hysterectomies in our practice are performed this way. This compares to a national average of 35%. This procedure has proven itself with less anesthesia time, less post-operative pain and the quickest recovery when compared to other approaches as referenced by the American Congress of OB/GYN’s committee opinion in October 2009.
If you do not meet criteria for the “incisionless” procedure. the doctors are proficient in performing laparoscopic hysterectomies. Combining these two approaches allows more than 90% of our hysterectomies to be minimally invasive. As numerous studies have shown, minimally invasive surgery greatly reduces risk of infection, shortens your hospital stay and reduces costs to you, as well as insurance companies.
TVH (Total Vaginal Hysterectomy):
The TVH has been around a long time and has been used to remove the uterus with or without ovaries in appropriate patients. This procedure is done all vaginally with no abdominal scars. In the past this was done using clamps and sutures which can cause tissue reaction and internal scarring. Often, the recovery period can be painful; and there is a risk after the procedure that adhesions may form. Dr. Robertson and Dr. Blanton employ more modern techniques, using titanium endo-staplers. Unlike sutures, these cause no tissue reaction with less pain and decrease the risk of adhesions. The titanium staples are tiny and non-magnetic allowing for future MRI’s if needed. We are the first OB/GYN’s in Shreveport/Bossier to use this technique and are co-authoring a nationwide paper on this technique. This offers a new dimension of safety and improved outcomes to a long-standing minimally invasive procedure.
Using laparoscopic guidance and new and innovative endo-mechanical devices (staplers, harmonic scalpels, endoscopic sutures), hysterectomies once deemed to be abdominal have now become laparoscopic candidates. There are three types of laparoscopic hysterectomies:
The LAVH uses the laparoscope and endo-mechanical devices to perform 80% of the hysterectomy via laparoscopy; the uterus and cervix are removed via a vaginal incision. It requires 3 small 5mm ports to be placed into the abdomen. They are closed with Dermabond (super glue style material). It allows removal of much larger uteri (fibroids, adenomyosis) vaginally as well as removal of uteri and ovaries (optional) with adhesions (endometriosis, prior C/S, prior abdominal surgeries) which in the past would have precluded a vaginal hysterectomy.
The LSH removes the body of the uterus and leaves the cervix in place. Although this procedure requires less time in the operating room, recent studies indicate leaving the cervix in place provides no measurable benefit. In fact, it carries a risk of future cervical dysplasia (pre-cancer), cervical cancer, and an increased risk of bleeding from the cervical stump.*
The LH uses the laparoscope to remove the entire uterus and to close the vaginal cuff. It requires a larger abdominal port site to remove the uterus in strips using a device called a morcellator. With respect to recovery, there is no advantage to this over an LAVH. Additionally, the use of the morcellator requires the placement of two 5mm ports and a 12 mm port, versus three 5 mm ports for an LAVH. There is a slight risk of a hernia with a 12mm port and a risk of cutting through an unknown neoplasm with the morcellator.
At Bossier Healthcare for Women, we perform the LAVH and TVH procedures. We believe these minimally invasive procedures allow for quicker recovery. The risk of future complications is lessened while patient safety is enhanced.
*Reference: Obstetrics & Gynecology 2007(SEP); 110(3): 705-6