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Hysterectomy

What is a hysterectomy?
Diagram of the female reproductive system A wide variety of benign (non-cancerous) conditions can affect a woman’s reproductive system, which consists of the uterus, vagina, ovaries and fallopian tubes. Most of these conditions affect the uterus, which is the hollow, muscular organ that holds a baby as it grows.

Gynecological conditions can cause chronic pain and heavy bleeding as well as other disabling symptoms. A few of these common conditions include:

  • Fibroids—non-cancerous growths in the uterine wall
  • Endometriosis—non-cancerous growths in the uterine lining
  • Prolapse—falling or slipping of the uterus

Women who experience these symptoms are often treated with a hysterectomy—the surgical removal of the uterus. According to the U.S. Department of Health and Human Services, this procedure is the second most common surgery for women in the United States; an estimated one-third of women will have a hysterectomy by age 60.

Types of hysterectomies
After meeting with your gynecologist and/or OB/GYN, he or she will recommend a type of hysterectomy, depending on your diagnosis. Types of hysterectomies include:

  • Supracervical hysterectomy—removes the uterus but leaves the 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 also possibly part of the vagina, fallopian tubes, ovaries and lymph nodes in order to stage the cancer—depending on how far it has spread, radical hysterectomies are commonly performed for patients with cervical cancer

Open, minimally invasive and laparoscopic hysterectomies
Today, many hysterectomies are performed using minimally invasive surgery. The primary technique is known as vaginal hysterectomy. This 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.

Surgeons still perform a majority of hysterectomies using an “open” approach, which is through a large abdominal incision. An open requires a 6–12 inch incision. When cancer is involved, the conventional treatment has always been open surgery.

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)1
  • Thick adhesions due to prior pelvic surgery, such as C-section2
  • Severe endometriosis 3
  • Non-localized cancer (cancer outside the uterus) requiring more extensive tissue removal, including lymph nodes

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

Robotic hysterectomy
This robotic surgery is a less invasive surgical procedure that combines the advantages of both conventional open and minimally invasive laparoscopic hysterectomies—but with far fewer drawbacks. Robotic hysterectomy is quickly becoming the treatment of choice for numerous surgeons at Gwinnett Medical Center–Duluth and worldwide. It is performed using the da Vinci® Robotic Surgical System, which enables surgeons to perform surgical procedures with unmatched precision, dexterity and control.

Diagram of open versus robotic hysterectomy incisionsFor most women, robotic hysterectomy offers numerous potential benefits over traditional, open surgical approaches, including:

  • Significantly less pain4
  • Less blood loss and fewer blood transfusions1
  • Minimally invasive surgical option for women with large, numerous or difficult to access fibroids2
  • Fewer complications and a lower risk of infection4
  • Shorter hospital stay4
  • Faster recovery and return to normal activities4
  • Small, dime-sized incisions for minimal scarring3

Download a FREE brochure to learn about robotic procedures offered at GMC–Duluth.

Request a FREE educational and testimonial DVD about robotic hysterectomies in the mail from Gwinnett Medical Center–Duluth.

Other hysterectomy options
While a hysterectomy is a relatively safe procedure, it may not be appropriate or necessary for all individuals or conditions. Alternative treatments that preserve the uterus may be available.

For example, robotic myomectomy (link to myomectomy page) may be an option for women with fibroids who want to preserve their fertility and/or uterus. Always ask your gynecologist or OB/GYN about all treatment options, as well as their risks and benefits.

For a physician referral, call 678-312-5000 or click here to find a doctor and search “robotic surgery.”

1Visco AG, Advincula AP, Robotic Gynecologic Surgery; Obstetrics and gynecology (2008) 112 (6), pp. 1369-1384
2 Advincula AP, Song A, Burke W, Reynolds RK; Preliminary Experience with Robot-Assisted Laparoscopic Myomectomy; Journal of the American Association of Gynecologic Laparoscopists (2004)11(4):511–518
3www.brighamandwomens.org/patient/robotics 4Piquion-Joseph JM, Navar A, Ghazaryan A, Papanna R, Klimek W, Laroia R, Robot-assisted gynecological surgery in a community setting; Journal of Robotic Surgery (2009) pp. 1-4