Treatments For Uterine Fibroids

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


Illustration of female anatomy

Types of Hysterectomy

There are various types of hysterectomy that are performed depending on the patient’s diagnosis. All hysterectomies involve removal of the uterus. What can vary are which additional reproductive organs and other tissues that may be removed. Types of hysterectomy include:

 

  • Partial or subtotal hysterectomy: This is also known as a supracervical hysterectomy. This procedure involves removing the uterus, but leaves the cervix intact. This decision is often based upon patient preference. Some women feel that leaving the cervix intact will preserve sexual function following surgery.2
  • Total hysterectomy: This procedure involves removing the uterus and the cervix. The vagina remains entirely intact. This is the most common type of hysterectomy performed.
  • Removal of the fallopian tubes and ovaries: These organs may or may not be removed during your hysterectomy procedure. This will depend upon your condition, age, and other factors. Often, the ovaries and fallopian tubes are left intact.3 Removal of the ovaries is called an oophorectomy. Removal of fallopian tubes and ovaries is called a salpingo-oophorectomy.

Approaches to Hysterectomy

Abdominal 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.


Vaginal Hysterectomy

A second approach to 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.


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 incision. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy.

 

You may encounter shorthand abbreviations describing different approaches to hysterectomy. Some of these are as follows:

 

  • Total Laparoscopic Hysterectomy (TLH): The uterus and cervix are removed using laparoscopic instrumentation through 3-5 small incisions made in the abdomen.
  • Laparoscopic Supracervical Hysterectomy (LSH): The uterus is removed, but the cervix is left in tact, using laparoscopic instrumentation through 3-5 small incisions made in the abdomen. The uterus is removed through one of the small incisions using an instrument called a morcellator.
  • Total Vaginal Hysterectomy (TVH): The uterus and cervix are removed through an incision deep inside the vagina. This is often the surgical approach to treat uterine prolapse.
  • Total Abdominal Hysterectomy (TAH): The uterus and cervix are removed through a large abdominal incision. The incision size can vary from 6-12 inches, depending upon the patient’s condition.

While minimally invasive vaginal and laparoscopic hysterectomies offer important 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

With laparoscopic hysterectomies, surgeons may be limited in their dexterity, since the instruments are straight and rigid, and by 2D visualization, both of which can potentially reduce the surgeon's precision and control when compared with traditional abdominal surgery.

da Vinci Hysterectomy

This procedure is performed using the da Vinci Surgical System, a breakthrough surgical platform which enables gynecologists to operate with unmatched precision, dexterity and control. da Vinci Hysterectomy, combines the advantages of conventional open and minimally invasive hysterectomies – but with potentially fewer drawbacks.

Comparison of hysterectomy incisions

da Vinci Hysterectomy offers numerous potential benefits over traditional approaches, including:

 

  • Significantly less pain6
  • Minimal blood loss and need for transfusion7,8
  • Fewer complications8,9
  • Shorter hospital stay8,9
  • Quicker recovery and return to normal activities5,6
  • Small incisions for minimal scarring
  • Better outcomes and patient satisfaction, in many cases8

Treatments for Uterine Fibroids:

 

  1. Center for Disease Control. Keshavarz H, Hillis S, Kieke B, Marchbanks P. Hysterectomy Surveillance — United States, 1994–1999. Morbidity and Mortality Weekly Report. Surveillance Summaries. July 12, 2002. Vol. 51 / SS-5. Page 1. www.cdc.gov/mmwr/PDF/ss/ss5105.pdf
  2. Harmanli OH, Khilnani R, Dandolu V, Chatwani AJ. Narrow pubic arch and increased risk of failure for vaginal hysterectomy. Obstet Gynecol. 2004 Oct;104(4):697-700.
  3. Paparella P, Sizzi O, Rossetti A, De Benedittis F, Paparella R. Vaginal hysterectomy in generally considered contraindications to vaginal surgery. Arch Gynecol Obstet. 2004 Sep;270(2):104-9. Epub 2003 Jul 10.
  4. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ. 2005 Jun 25;330(7506):1478. Review.
  5. http://www.merck.com/mmhe/sec22/ch242/ch242b.html#sec22-ch242-ch242b-83
  6. http://www.nccn.org/patients/patient_gls/_english/_pain/2_assessment.asp  
  7. http://www.merck.com/mmhe/sec22/ch252/ch252f.html?qt=pain%20during%20
    intercourse&alt=sh  
  8. Boggess  JF. Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm. J Robotic Surg 2007 1:31-3
  9. Payne TN, et al. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol. 2008 May-June;15(3):286-91

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.