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HYSTERECTOMY

Hysterectomy no matter how it is performed is a “major” surgery and involves major decisions. This is a major decision for a woman and requires a discussion between the surgeon and the patient and other family members or friends as she requests. The choice to have a hysterectomy usually comes after a woman has had problems with pain or heavy menses and conservative measures have failed. It can be a very emotional decision too since women are afraid of how it will affect them as a “woman.”

Laparoscopic Supra-Cervical Hysterectomy

(LSH, Subtotal Hysterectomy)

In this procedure the cervix remains but the uterus and fallopian tubes are removed. (The ovaries are a separate issue. See “ovary removal at hysterectomy”). This type of hysterectomy is the least invasive, has the lowest infection rate, has the least risk to injuring other organs (in my opinion) and has the quickest return to normal activities.

Incisions: The LSH surgery is done through a pencil size incision (< ¼ inch) inside the bellybutton, a pencil size incision in the right lower abdomen and a ½ inch incision in the left lower abdomen. On some occasions another pencil size incision will be made in the lower abdomen just above the pubic hair area when a uterus is very big or a difficult surgery is encountered.

Remember each patient is unique and each surgical situation is unique (previous scars, tattoos, etc.). We will estimate for you where you incisions will be in your specific situation. Some women who have had previous surgery will need a small incision in another location.

Who can have this type of hysterectomy? Most women are eligible for this type of surgery unless they have:

  • Severe pain with intercourse.
  • Pre cancer or cancer of the cervix.
  • Pre cancer or cancer of the endometrium (lining of the uterus).

You will not be given this option unless you are a good candidate.

Most patients go home the same day and some stay over night depending on the circumstances. The patient can drive in 5 days and return to work in about 2 weeks depending on her job description. Intercourse can resume in 2 weeks.

Pros

  • Can drive in 2 days.
  • Can run in 5 days.
  • Intercourse in 2 weeks.
  • No vaginal incision so lower infection rate and you cannot get a break open of the vaginal incision.
  • Cervix left to help with support.
  • Less need to push bladder or rectum off of cervix to complete hysterectomy.
  • Return to work in two weeks or less (depends on your job).

Cons

  • In 5-10% of women, cyclic spotting can occur when you cycle is due.
  • You can have an abnormal PAP smear In the future (if your partner gives you a sexually transmitted virus-HPV).
  • A few women need the cervix removed at a later date.

NOTE: AS IN ALL SURGERIES THE RISK OF AN OPEN OR FULL INCISION (BIKINI CUT OR AN UP AND DOWN CUT) EXISTS. IT IS RARE FOR DR. KONDRUP TO HAVE TO MAKE THIS KIND OF INCISION AND WE TRY TO PREPARE FOR ALL FACTORS TO PREVENT THIS.

Total Laparoscopic Hysterectomy

(TLH, Total Hysterectomy)

In this procedure the cervix, uterus and fallopian tubes are removed. (The ovaries are a separate issue. See “ovary removal at hysterectomy). This type of hysterectomy is slightly more invasive because now an incision is made in the vagina and the bladder and rectum need to be pushed off of the cervix. Also, sutures have to be placed to close the vaginal incision so the risk of injury to the bladder increases.

Incisions: The TLH surgery is done through the same incisions as the LSH (see above), however, often we can use only the pencil size ( <1/4 inch ) incisions for the entire surgery. On some occasions another pencil size incision will be made in the lower abdomen just above the pubic hair area when a uterus is very big or a difficult surgery is encountered.

Remember each patient is unique and each surgical situation is unique (previous scars, tattoos, etc.). We will estimate for you where you incisions will be in your specific situation. Some women who have had previous surgery will need a small incision in another location.

Who can have this type of hysterectomy? Most women are eligible for this type of surgery unless they have:

  • Severe narrowing of the vagina.
  • Cancer of the cervix.
  • Cancer of the endometrium (lining of the uterus).

You will not be given this option unless you are a good candidate.

Patients can go home the same day or the next. The patient can drive in 5 days and return to work in about 4 weeks depending on her job description. Intercourse can resume in 8 – 12 weeks depending on how long the vagina takes to heal. Women with low estrogen levels, smokers and diabetics can take longer to heal.

Pros

  • No cyclic spotting from the cervix.
  • Cannot get abnormalities of the cervix.
  • Small abdominal incisions.
  • Return to work in four weeks or less (depends on your job).

Cons

  • A small percentage of women can have separation of the vaginal closure incision (dehiscence) and would need surgical closure.
  • A few women could get an infection in the vaginal incision and need treatment including hospitalization.
  • The support of the vagina can be impaired and you would need surgery to repair that.
  • Intercourse in 8-12 weeks. (depends on when the vagina heals).

NOTE: AS IN ALL SURGERIES THE RISK OF AN OPEN OR FULL INCISION (BIKINI CUT OR AN UP AND DOWN CUT) EXISTS. IT IS RARE FOR DR. KONDRUP TO HAVE TO MAKE THIS KIND OF INCISION AND WE TRY TO PREPARE FOR ALL FACTORS TO PREVENT THIS.

Ovary removal at hysterectomy

The recommendation to remove the ovaries at the time of hysterectomy is continually changing. The general rule is to leave the ovaries at the time of hysterectomy before the age of 50 unless there is disease, family history of ovarian cancer, the patient carries the genetic predisposition to ovarian cancer and other factors that may be unique to each patient. Ovary removal prior to menopause may have a profound effect on a woman’s hormones and can increase other health risks. Ovarian preservation on the other hand may have its own risks each of which may include the risk of ovarian cancer, cyst of the ovaries, twisting of an ovary (torsion) and other factors that can be unique to that specific woman.

Ovary removal or preservation is something that must be discussed with the patient well ahead of the surgery date.

The chance of a traditional cut

A traditional abdominal incision may occur when:

  • A difficult or dangerous condition exists during the surgical procedure.
  • A complication occurs.
  • In the opinion of the surgeon the patient would benefit more from the open procedure.

An open procedure involves a cut in the skin either in a bikini cut or a cut that is vertical on the skin. An open cut increases the risk of hernia (weakening of the healing site), infection and scar tissue. It also has more pain associated with it as well as a longer recovery period.

We try to avoid the open cut whenever possible but patients must help too by losing weight and improving their health especially by stopping smoking.

Robotic Hysterectomy/ Surgery

Lourdes hospital acquired the daVinci surgical robot several years and Dr. Kondrup was the first to perform robotic surgery in The Southern Tier. He then became Chairman of the robot committee and continued in that role as the robot committee was combined with the Minimally Invasive Surgery committee.

Dr. Kondrup feels that the robot plays a crucial role in minimally invasive surgery and he utilizes it when indicated. The robot, however, is just another surgical instrument. It does not make the surgeon a better surgeon nor does it do the surgery for the surgeon. It does allow the surgeon to see in 3D and give them a better depth perception when they cannot get used to traditional laparoscopic surgery.

The robotic incisions are generally bigger than the traditional incisions that Dr. Kondrup uses. Furthermore, it may be difficult at times to leave the telescope inside the belly button due to the robot design. Like all surgeries the robot has its own risks and complications.