2. Alphabet soup

3. Reasons for Hysterectomy
FOCUS: HYSTERECTOMY
Definition
Types of Hysterectomy
Reasons for Hysterectomy
Surgical Options
TITLE SLIDE
Advantages/Disadvantages
Questions & Answers

4. ?
WHAT IS A HYSTERECTOMY
TITLE SLIDE

5. HYSTERECTOMY: THE SURGICAL REMOVAL OF THE UTERUS

6. •Uterus is a “pear shaped” muscular organ

7. •Uterus is a “pear shaped” muscular organ
•Also known as the womb
• Function: to carry the fetus during pregnancy

8. •Uterus
•Vagina
•Fallopian Tubes
•Ovaries

9. •The Uterus is positioned in the female pelvis in between the bladder and the rectum

10. HYSTERECTOMY FACTS Second most commonly performed gynecologic
procedure in the U.S., after Cesarian Section
Over 600,000 hysterectomies are
performed annually in the U.S.
1 in 3 women will have a hysterectomy
by age 60
• “Hysterectomy Rates in the United States,2003”, Jennifer M. Wu, MD,MPH,
Over 65% of hysterectomies are still
performed through an abdominal incision ( TAH )

11. ARE THERE DIFFERENT TYPES OF HYSTERECTOMY?
ARE THERE DIFFERENT TYPES OF HYSTERECTOMY
TITLE SLIDE

12. 3 HYSTERECTOMY TYPES Total Hysterectomy Subtotal Hysterectomy
Radical Hysterectomy

13. TOTAL HYSTERECTOMY: SURGICAL REMOVAL OF THE UTERUS & CERVIX
Also known as a Complete Hysterectomy

14. SUBTOTAL HYSTERECTOMY:
• subtotal hysterectomy also known as a SUPRACERVICAL HYSTERECTOMY OR PARTIAL HYSTERECTOMY
SURGICAL REMOVAL OF THE UTERUS
LEAVING THE CERVIX IN PLACE

15. RADICAL HYSTERECTOMY:
SURGICAL REMOVAL OF THE UTERUS,CERVIX,
AND PELVIC LYMPH NODES. OTHER TISSUE
INCLUDING OVARIES, FALLOPIAN TUBES, AND SOME OF THE VAGINA MAY BE REMOVED.

16. OOPHORECTOMY:
SURGICAL REMOVAL OF AN OVARY

17. BILATERAL SALPINGO OOPHORECTOMY:
SURGICAL REMOVAL OF BOTH OVARIES AND FALLOPIAN TUBES

18. WHY HAS YOUR DOCTOR RECOMMENDED HYSTERECTOMY?
WHY HAS YOUR DOCTOR RECOMMENDED HYSTERECTOMY
TITLE SLIDE

19. INDICATIONS FOR HYSTERECTOMY
Fibroids
Endometriosis
Prolapse
Cancer
Adhesions
Severe Pelvic Pain
Abnormal Bleeding

20. HOW WILL MY DOCTOR PERFORM THE HYSTERECTOMY?
HOW WILL MY DOCTOR PERFORM THE HYSTERECTOMY
TITLE SLIDE

21. 3 HYSTERECTOMY OPTIONS Total Abdominal Hysterectomy ( TAH )
Vaginal Hysterectomy ( VH )
Laparoscopic Hysterectomy ( LH )

22. TAH
TAH

23. TOTAL ABDOMINAL HYSTERECTOMY
Open Surgery
Performed through a 4-8 inch
incision in the abdominal wall
The most common approach
to hysterectomy
Over 65% of all hysterectomies

24. VH VH

25. VAGINAL HYSTERECTOMY Performed through the vagina
No abdominal incisions
Second most common approach
to hysterectomy
Over 20% of all hysterectomies

26. WHAT IS LAPAROSCOPIC SURGERY?
WHAT IS LAPAROSCOPIC SURGERY
TITLE SLIDE

27. LAPAROSCOPIC SURGERY Minimally Invasive Surgery ( MIS )
“LAPARO” = ABDOMEN
Laparoscope used to see inside of abdomen
Special tubes called “ports” are inserted
Into tiny incisions in the abdomen
Laparoscopic instruments are then
inserted into the ports

29. LH LH

31. LAPAROSCOPIC HYSTERECTOMY
First LH perfomed in 1989
Newest approach to hysterectomy
Use a Laparoscope to see inside of abdomen
Laparoscopic instruments are inserted
Into 3-4 half inch incisions in abdomen
ONLY % of all hysterectomies

32. LAPAROSCOPIC HYSTERECTOMY
LAVH
Laparoscopically Assisted Vaginal Hysterectomy
LSH
Laparoscopic Supracervical Hysterectomy
TLH
Total Laparoscopic Hysterectomy
Robotic Hysterectomy ( da Vinci )

33. LAVH Laparoscopically Assisted Vaginal Hysterectomy
Technique involves initially performing a laparoscopic surgery
Uterus is detached using laparoscopic
instruments
Uterus is removed through the vagina
Initially bridged the gap between the need
for Abdominal – Vaginal Hysterectomy

34. LSH Laparoscopic Supracervical Hysterectomy
Technique involves detaching the uterus
with or without the ovaries using laparoscopic
instruments
Uterus is then released or amputated from
cervix
Leaves a portion of the cervix behind
Instrument called a morcellator allows the
tissue to be cut into pieces then removed
through the abdominal ports

35. TLH Total Laparoscopic Hysterectomy Developed as a substitute for TAH
Removes entire uterus along with cervix,
with or without ovaries laparoscopically
Uterus may be removed in pieces through
the morcellator
Uterus may be removed through the
Laparoscopic incision at the top of the vagina
Incision is then closed laparoscopically

36. da Vinci Robotic Hysterectomy da Vinci system was approved in 1995
Involves a 3D approach to laparoscopic surgery
da Vinci system was approved in 1995
Surgeon operates at an ergonomic console
equipped with 3D vision and control of wristed
instruments
Allows for increased dexterity and 3D vision

37. da Vinci
Robotic Hysterectomy

38. WHAT ARE THE ADVANTAGES & DISADVANTAGES OF TAH, VH, & LH?
WHAT ARE THE ADVANTAGES & DISADVANTAGES OF TAH, VH, & LH
TITLE SLIDE

39. ADVANTAGES TOTAL ABDOMINAL HYSTERECTOMY Easy to see pelvic organs
Removal of any sized uterus
Performed even with adhesions
Surgeon’s have the most experience
with this kind of hysterectomy

40. DISADVANTAGES TOTAL ABDOMINAL HYSTERECTOMY Large abdominal scar
More pain is reported
Increased adhesions
Increased risk of post-operative complications
Longer hospital stay
Prolonged recovery
More expensive than Vaginal Hysterectomy

41. ADVANTAGES VAGINAL HYSTERECTOMY Less post-operative pain
No visible scar
May be preferable to TAH for obese woman
Less intra-operative & post-operative
complications

42. ADVANTAGES VAGINAL HYSTERECTOMY Shorter operating time
Shorter hospitalization
Faster recovery time
Less cost

43. DISADVANTAGES VAGINAL HYSTERECTOMY
Limited visualization of uterus & pelvic organs
Diagnosis & treatment of disease is restricted
Difficult to remove large fibroids
Difficult to perform an Oophorectomy
Women with a large uterus, severe endometriosis,
adhesions, or nulliparous may not be candidates
Less experienced surgeons may not be comfortable

44. ADVANTAGES LAPAROSCOPIC HYSTERECTOMY
Magnification of anatomy & pathology
Minimal tissue trauma
Less blood loss
Less adhesion formation

45. ADVANTAGES LAPAROSCOPIC HYSTERECTOMY Small incisions
Less chance of wound infection
Less painful
Shorter hospital stay
Quicker recovery
Saved work hours

46. DISADVANTAGES LAPAROSCOPIC HYSTERECTOMY Longer operating time
More expensive
Few surgeons have experience & training
Demands new skills for staff
Difficult with large fibroids

47. WHAT DOES THE FUTURE HOLD?
WHAT DOES THE FUTURE HOLD
TITLE SLIDE

48. FUTURE OF GYNECOLOGY Office micro-laparoscopy or mini-laparoscopy
Uses for diagnosis of emergency room patient
Perform office biopsies and sterilization
Evaluation of abdominal pain
Evaluation of infertility