Alphabet soup

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

? WHAT IS A HYSTERECTOMY TITLE SLIDE

HYSTERECTOMY: THE SURGICAL REMOVAL OF THE UTERUS

•Uterus is a “pear shaped” muscular organ

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

•Uterus •Vagina •Fallopian Tubes •Ovaries

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

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 )

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

3 HYSTERECTOMY TYPES Total Hysterectomy Subtotal Hysterectomy Radical Hysterectomy

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

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

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.

OOPHORECTOMY: SURGICAL REMOVAL OF AN OVARY

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

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

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

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

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

TAH TAH

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

VH VH

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

WHAT IS LAPAROSCOPIC SURGERY ? WHAT IS LAPAROSCOPIC SURGERY TITLE SLIDE

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

LH LH

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 10 -11% of all hysterectomies

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

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

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

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

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

da Vinci Robotic Hysterectomy

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

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

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

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

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

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

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

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

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

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

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