Obstetrics and Gynecology

Hysterectomy

Physicians perform hysterectomy – the surgical removal of the uterus – to treat a wide variety of uterine conditions. Each year in the U.S. alone, doctors perform approximately 600,000 hysterectomies, making it the second most common surgical procedure.1

Types of Hysterectomy

There are various types of hysterectomy that are performed depending on the patient’s diagnosis:

  • Supracervical hysterectomy – removes the uterus, leaves cervix intact
  • Total hysterectomy – removes the uterus and cervix
  • Radical hysterectomy or modified radical hysterectomy – a more extensive surgery for gynecologic cancer that includes removing the uterus and cervix and may also remove part of the vagina, fallopian tubes, ovaries and lymph nodes in order to stage the cancer (determine how far it has spread).

Approaches to Hysterectomy

Surgeons perform the majority of hysterectomies using an “open” approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6-12 inch incision. When cancer is involved, the conventional treatment has always been open surgery using a large abdominal incision, in order to see and, if necessary, remove related structures like the cervix or the ovaries.

A second approach to hysterectomy, vaginal hysterectomy, involves removal of the uterus through the vagina, without any external incision or subsequent scarring. Surgeons most often use this minimally invasive approach if the patient’s condition is benign (non-cancerous), when the uterus is normal size and the condition is limited to the uterus.

In laparoscopic hysterectomy, the uterus is removed either vaginally or through small incisions made in the abdomen. The surgeon can see the target anatomy on a standard 2D video monitor thanks to a miniaturized camera, inserted into the abdomen through the small incisions. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy alone.

While minimally invasive vaginal and laparoscopic hysterectomies offer obvious potential advantages to patients over open abdominal hysterectomy – including reduced risk for complications, a shorter hospitalization and faster recovery – there are inherent drawbacks. With vaginal hysterectomy, surgeons are challenged by a small working space and lack of view to the pelvic organs. Additional conditions can make the vaginal approach difficult, including when the patient has:

  • A narrow pubic arch (an area between the hip bones where they come together)2 
  • Thick adhesions due to prior pelvic surgery, such as C-section3 
  • Severe endometriosis 4
  • Non-localized cancer (cancer outside the uterus) requiring more extensive tissue removal, including lymph nodes

With laparoscopic hysterectomy, surgeons may be limited in their dexterity and by 2D visualization, potentially reducing the surgeon's precision and control when compared with traditional abdominal surgery.

da Vinci Hysterectomy

A new, minimally invasive approach to hysterectomy, da Vinci Hysterectomy, combines the advantages of conventional open and minimally invasive hysterectomies – but with far fewer drawbacks. da Vinci Hysterectomy is becoming the treatment of choice for many surgeons worldwide. It is performed using the da Vinci System, which enables surgeons to perform surgical procedures with unmatched precision, dexterity and control.

 

Single Site Hysterectomy
A BRIEF HISTORY OF HYSTERECTOMIES

Vaginal hysterectomy dates back to ancient times. The procedure was performed by Soranus of Ephesus (in what is modern-day Turkey) 120 years after the birth of Christ.

The first abdominal hysterectomy was performed by Charles Clay in Manchester, England in 1843.

The transverse incision was introduced by Johanns Pfannenstiel in the 1920s

Hysterectomy became safer in the 1930s with the introduction of anesthesia, antibiotics and antisepsis, blood transfusions and intravenous therapy.

The advent of endoscopic surgery ushered in the first laparoscopic hysterectomy in Pennsylvania in 1988.

First case series reporting the use of a computer-enhanced surgical robot for performing hysterectomy in humans in medical literature is credited to Dr. C. Diaz-Arrastia at UTMB in the 2002.

In 2011, another first for Texas and UTMB: the first robotic unit including a full technology package (dual console and fluorescent imaging) starts serving patients at UTMB. The unit allows two surgeons to apply their individual expertise to help a patient at same time. In the same year, more than 100 robotic surgeries performed at UTMB.

In 2011, cornerstone medical article written by UTMB faculty members helps to regulate and set national guidelines for robotic surgery. The article is “Medicolegal review of liability risks for gynecologists stemming from lack of training in robot-assisted surgery.”

Robotic and Minimally Invasive Gynecology Daytime Direct Number:
(409) 370-2038

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