A Fresh Look at Hysterectomy

Last year, Nicole was miserable -- heavy periods, lots of cramping. Not only did she have fibroids, but her uterus and bladder were slipping downward, causing serious discomfort. Nicole needed a hysterectomy, plus bladder repositioning, her doctor said.

He advised her that abdominal hysterectomy was the best option -- "so they could see everything clearly," she tells WebMD. That involves a big incision in the abdomen, about two days in the hospital, and nearly two months of recovery.

"I didn’t like the idea of abdominal surgery," Nicole says. "I work, and I have two kids. I knew I needed to be up and about to take care of my girls. I didn't have time for the six- to eight-week recovery."

That's when she got a second opinion, which resulted in a total laparoscopic hysterectomy. It left almost no scar, and she had minimal downtime.

"The next morning, I pretty much walked out of the hospital," she says. "By the second day, I felt wonderful. I never did take any of the pain medications. I didn't have any pain." Two weeks later, she was back at work.

Laparoscopic Hysterectomies

Nicole's laparoscopic hysterectomy is a form of minimally invasive surgery. Laparoscopic surgery is used in gallbladder and appendectomy surgeries, and has been adapted to surgeries in cardiology, urology, and other fields.

But in gynecology, the acceptance of laparoscopy has come more slowly. Indeed, more than 600,000 hysterectomies are performed in the U.S. annually. While upwards of 80% are abdominal surgeries, they could be done as laparoscopic or vaginal hysterectomies, doctors say.

The trend is indeed moving in that direction -- and the patient's recovery is the biggest reason, says Nicole's surgeon, F. Ralph Dauterive, MD, chairman of obstetrics and gynecology at Ochsner Health Center in Baton Rouge. "There's a shorter hospital stay and recovery, compared to abdominal surgery, so your return to normal activity is quicker."

Hysterectomy Recovery: A Quick Comparison

It's easy to see why women opt for laparoscopic hysterectomy. Why suffer with a big incision if you don't have to? Why have a month or more downtime if it's not necessary? Compare the three options you have:

• The standard abdominal hysterectomy is major surgery with a big belly incision, and a slow, painful recovery. Approximate recovery time: Six weeks.
• The vaginal hysterectomy can be done entirely through the vagina, or using a laparoscope (the laparoscopic-assisted vaginal hysterectomy, or LAVH). Only women with a relatively small fibroid, small uterus, and no previous caesarean sections can have this. Approximate recovery time: Two weeks.
• The total laparoscopic hysterectomy involves only small "keyhole" incisions, often made in the navel or abdomen. Approximate recovery time: Two weeks or less.

The Pros and Cons of Laparoscopic Hysterectomy

Nearly any woman is a good candidate for total laparoscopic hysterectomy -- regardless the size of her fibroid or uterus, whether she's had a caesarean section or not, explains Gladys Tse, MD, assistant professor of obstetrics and gynecology at Washington University School of Medicine in St. Louis.