What does hysterectomy mean and when is it indicated?
The hysterectomy is the surgical procedure that involves the removal of the uterus. The total hysterectomy implies the removal of the uterus, as well as the cervix, the component which stabilizes the uterus by its attachment to the pelvic ligaments and is connected distally to the vagina.
The decision involving the removal the ovaries and the fallopian tubes is taken with regard to their ultra-sonographic and intraoperative aspect, the age and the pathology of the patient.
- Uterine fibromas – with an incidence of approximatively 40% in women at any age. They are almost always benign, but may be the cause of important menstrual bleeding, intermenstrual bleeding or severe abdominal pain. Multiple fibromas may be present simultaneously.
- Adenomyosis, a relatively frequent form of endometriosis which involves the implantation of endometrial tissue on the uterine muscular fibers.
- Deep endometriosis.
- Untreatable pelvic pain
- Infection involving the fallopian tube and/or the ovaries..
- Abnormal uterine bleeding.
- Endometrial hyperplasia or early-stage endometrial carcinoma.
What is the current treatment standard?
The surgical techniques regarding hysterectomy have evolved, from classic surgery to minimally-invasive surgery, via laparoscopy or robotic procedures, improving the accuracy of the surgical intervention, as well as the patient recovery time.
Laparoscopic surgery – how is it performed?
The laparoscopic hysterectomy is performed under general anesthesia. A small incision is made at the umbilical level in addition to three smaller abdominal incisions. The optical instrument is introduced in the abdominal cavity through the umbilical incision. The surgical instruments that hold, coagulate and cut the uterus are placed through the secondary, smaller, incisions. The ligaments and vascular elements of the uterus (with or without the adnexa) are cut, freeing the uterus and making the vaginal removal possible. The vaginal mucosa is then sutured laparoscopically. Finally, after the abdominal cavity is thoroughly checked for any bleeding, the surgical instruments and the laparoscope are removed, followed by the suture of the incisions.
The advantages of laparoscopic hysterectomy:
- Small incisions that are barely visible.
- Reduced post operatory pain.
- Minimal bleeding.
- Low risk of subsequent infections.
- Low incidence of post interventional intra-abdominal adhesions.
- Lower hospitalization period – 48-72 hours, compared to 4-5 days usually spent after open abdominal surgery.
- Early mobilization of the patient – 24 hours post-intervention.
- Rapid recovery (1-3 weeks), compared to the open abdominal surgery (4-8 weeks).
What are the risks?
The most frequent complications involve the lesion of the intestines, bladder, ureter or primary blood vessels. In our practice, none of these intra-operatory or post-operatory complications were met, in over 150 yearly laparoscopic hysterectomies.
Robotic surgery, a superior approach of the hysterectomy
What are the advantages of the robotic hysterectomy?
The robotic intervention is the most advanced form of minimally invasive surgery, using state of the art technology. The surgical instruments and the optical camera are maneuvered by a robotic system, controlled by the surgeon through a console. The robotic system offers a superior range of motion compared to the human hand, as well as an enlarged, high-definition, three-dimensional field of view of the operating field. The da Vinci Xi robotic surgery system is equipped with a wide range of advanced instruments for minimally invasive interventions. However, the procedure is performed by the surgeon, operating the robot via the control console. Robotic surgery overcomes all limitations of laparoscopic surgery, greatly improving the image quality of the operating field, amplifying the accuracy and dexterity of surgical movements, as well as granting the surgeon increased comfort. All these taken into account, complex interventions can be performed securely and with ease, fewer post-operatory complications, lower hospitalization period, and greatly improved results. This type of approach is an advanced form of minimally invasive surgery, with all the following advantages compared to open abdominal surgery:
- High precision;
- Minimal intra-operatory blood loss;
- Fewer post-operatory complications;
- Shorter hospitalization period;
- Faster patient recovery – the patient is mobilized few hours after the surgery;
- Small post-operatory scarring.
Furthermore, compared to the laparoscopic approach, robotic surgery grants certain advantages:
- The surgeon is able to reach less-accessible areas;
- Precise movement of the instruments;
- 3D HD imaging, with increased stability, with the ability to zoom in up to 10 times.
The robot arms have 7 degrees of motion (compared to the only 4 degrees of the laparoscopic approach) and are very versatile, allowing the micro-instruments to nearly perform a double clockwise rotation – a 540 degree range of motion. All these qualities greatly improve the end surgery result and help perfect the surgeon’s motions.
What is to be expected of this surgical procedure? The patient is discharged 48 hours after surgery. Normal activity is resumed in less than a week. The sutures are either removed 10-14 days after surgery, or not at all, if absorbable sutures are used. What are the risks? The most frequent complications involve the lesion of the intestines, bladder, ureter or primary blood vessels. In our practice, none of these intra-operatory or post-operatory complications were met, in over 50 yearly robotic hysterectomies. What are the post-surgery recommendations?
- Physical and sexual rest 6 weeks following the surgery;
- A special diet in order to avoid bloating and constipation;
- Careful rinsing of the post-surgical incisions with warm water and neutral soap (bathing is prohibited in the first month following the surgery).
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