Minimally Invasive Gynecologic Surgery for Fibroids and Hysterectomy

UNIVERSITY PARK – Through the use of laparoscopy and state-of-the-art technology surgeons can perform one of the most common surgical procedures in the United States: hysterectomy. More than 600,000 hysterectomies are done each year and one in three women in the United States will have a hysterectomy by age 60. MIS allows the uterus to be removed without the large incision required by an open procedure. The surgeon gains access to the abdomen through small incisions.

Benefits of MIS for hysterectomy include: faster recovery, shorter hospital stays, and –less pain and scarring than women who have a total abdominal hysterectomy.

With MIS hysterectomy, the hospital stay is usually one day, and normal activity can be resumed in about two weeks.

There are two types of laparoscopic hysterectomies:

— Laparoscopic supracervical hysterectomy: This is a MIS procedure where only the uterus is removed using laparoscopic instruments; the cervix and vagina are preserved, unchanged. It has been suggested that by retaining the cervix and vagina unchanged, women maintain better pelvic support. In addition, some women also feel that their sexual response is better maintained by keeping their cervix. Women who choose to have an LSH will need to continue with their regular Pap screening.

— Total laparoscopic hysterectomy: This is similar to a vaginal hysterectomy, the uterus and cervix are removed through an incision at the top of the vagina cuff under view of the laparoscope using specialized laparoscopic surgical tools. The vaginal incision is closed laparoscopically.

Whether a woman chooses to retain her cervix with an LSH or have a more traditional hysterectomy via TLH is a personal decision. Women can talk with their surgeons about the risks and benefits of each MIS hysterectomy option.

Laparoscopic myomectomy is another MIS option that is available for women for the treatment of myomas or fibroids. Fibroids are a smooth muscle growth of the uterus and can be a common gynecologic complaint. As many as one in four women have fibroids, and these fibroids can cause abnormal or heavy vaginal bleeding. Fibroids can grow to such an excessive size that they can be the cause of many abdominal and pelvic complaints for women. They may cause pelvic pressure by pushing on a woman’s bladder or rectum and they may be the source of pain during intercourse. Uterine fibroids may cause painful cramping during a woman’s menstrual cycle. Symptomatic uterine fibroids are the most common reason for hysterectomy. Myomectomy or surgical removal of the fibroids is an option for women who wish to retain their uterus. Myomectomy allows a woman to have removal of the fibroids while preserving their fertility. The majority of myomectomy procedures are done via laparotomy or abdominal incision. However, many studies have shown that postoperative morbidity was less and recovery faster with a laparoscopic approach.

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