Worth the Wait
Approximately 600,000 hysterectomies are preformed annually in the United States. This surgical procedure is the second most frequently performed on reproductive-age women, only exceeded by cesarean sections. More than one-third of all American women will have undergone a hysterectomy by their 60th birthday. A review of recent data shows that currently 65 percent of all hysterectomies are per- formed using the traditional abdominal approach. Although hysterectomy is less commonly performed today due to advances in endometrial ablation and progesterone-containing intrauterine devices for abnormal bleeding, it will continue to be a necessary option for the treatment of abnormal bleeding, fibroids, pelvic pain and cancer.
Like in many surgical fields, less-invasive laparoscopic techniques allow patients to have a surgical procedure, while allowing a much easier recovery with less postoperative pain, less time missed from work and an earlier return to performing daily activities. But few have had such a dramatic impact as the recently developed laparoscopic supracervical hysterectomy (LSH). The LSH technique is rapidly gaining popularity because the procedure has many advantages over total abdominal hysterectomy (TAH).
An LSH involves two 5 mm incisions and one 15 mm incision. The cervix is retained, which theoretically has the advantage of aiding in pelvic support. With this technique, the supporting ligaments of the uterus and the vascular pedicles of the uterus are cauterized and transected, and the cervical-uterine junction is transected. With the aid of a laparoscopic morcellator, the uterus is removed in pieces and brought out through the 15 mm incision. Contra- indications to LSH would include a patient with suspicion for cervical or endometrial cancer, or someone who isnÕt willing to continue with pap surveillance. The entire procedure is usually performed in less than two hours, depending upon the size of the uterus, pelvic adhesions and mobility of the uterus. Removal of the fallopian tubes and ovaries is commonly already performed laparoscopically and can be done in conjunction with the removal of the uterus, if needed.
Injury to the urinary tract, which occurs in 0.5 to 3 percent of cases when total hysterectomy is performed is the most frequent cause of litigation after TAH; supracervical hysterectomy requires less mobilization of the bladder, and minimizes the risk of injury to the ureters and bladder. LSH is also associated with lower rates of wound infection, hematoma and vaginal cuff infections/granulation tissue formation. continued ...