Considering Hysterectomy? What is it and what are your options? Brookings Health System

My name is Ellen Hopper. I'm an OB-GYN here in Brookings. I work for the Avera Brookings Medical Clinic, and also do surgeries and deliveries over at the Brookings Health System.

What is a Hysterectomy?

A hysterectomy is a very common procedure. About 600,000 hysterectomies are performed in the U.S. every year, and about one in three women by the age of 60 will undergo a hysterectomy for a variety of reasons.

Reasons for Hysterectomy

The most common reason is just abnormal uterine bleeding, and whether that's bleeding in between periods or bleeding heavily for long periods of time throughout the month. There are lots of other reasons why people have abnormal bleeding, like uterine fibroids, anovulation or changes in hormones that women undergo just prior to menopause. 

Pelvic organ prolapse or cancer, women who have uterine or ovarian cancer, the recommendation is to have hysterectomy for those patients. Another reason for a hysterectomy would be pelvic pain, which can be caused by endometriosis where the lining of the uterus actually grows outside the uterus, on the bowel or bladder, on the ovaries, or something called adenomyosis, where the lining of the uterus grows into the muscle area of the uterus and that causes heavy and painful periods for people. Those are also reasons for a hysterectomy.

Types of Hysterectomy

Traditionally, hysterectomies in the past were performed by an abdominal route. Women had to have a big open abdominal incision. Now the recommendations are more for minimally invasive technology. Vaginal hysterectomy is an option for some women, where we make an incision vaginally and then remove the uterus through the vagina.

And then, laparoscopic hysterectomy is sort of a combination of both the abdominal hysterectomy and the vaginal hysterectomy. We make very small incisions on the abdomen and we perform the hysterectomy with laparoscopic tools. We use a small camera that helps us to visualize the ovaries and the tube, the blood supply, and things like that, abdominally, which gives us a very good view. And then, we actually remove the specimen, the uterus, the tubes, the ovaries through the vagina so you don't have to have a big open abdominal incision.

Robotic Assisted Surgery

Robotic hysterectomies are a new type of laparoscopic hysterectomy. You have small incisions and the specimen is removed vaginally, so you can avoid the big abdominal incision.

We have 3D visualizations. We have wristed instruments. With the traditional laparoscopic procedure, we're using long instruments that we have to torque on the patient. The robotic technology gives us little tiny wristed instruments inside the patient, which can help with precision and we're able to move the instruments in a 360-degree rotation just like you would your wrists.

Benefits of Robotic Assisted Surgery

There's quite a bit less blood loss with the robotic technology, less pain for patients with the smaller incisions, shorter recovery time generally, shorter hospital stays, which, of course, benefit the patient.

Who can Benefit from Robotic Surgery?

Any woman is a good candidate for a robotic assisted hysterectomy. If you're leaving the ovaries behind and you can remove everything vaginally, that's the preference. But a lot of women who are overweight are very good candidates for robotic surgery, that might not be good candidates for a traditional laparoscopic surgery. Women who have endometriosis or who have had lots of other surgeries like gallbladder removal, C-sections, hernia repairs, those sorts of things where there's likely a lot of scar tissue in the abdomen are great candidates for robotic surgery.

Hospital Stay

Some women, after a da Vinci robotic assisted surgery, can actually leave the hospital the same day. For the most part, we keep people overnight, one night, but there is the potential for women to leave actually the same day. Really, the criteria for when a patient can leave the hospital after a hysterectomy are we want their pain controlled, they need to be awake enough after anesthesia, that they can tolerate liquids, that they can urinate on their own, and that they can get up and ambulate or walk around without any problems. So those are the minimum criteria for people to be able to leave. And so there are some women who do want to leave the hospital the same day. Of course, it helps with cost and things like that. Some women prefer just to stay overnight and make sure they're doing well and go home the next day.

Things to Consider Before a Hysterectomy

Women should know that a hysterectomy is a major surgery. So there are risks associated with surgery, risks of bleeding and infection. Depending on the patient's medical history, those risks can be sometimes greater than a woman who is otherwise healthy. Surgery, of course, is not something that women should go into lightly, but the risks are fewer and recovery times are better now that we have these minimally invasive options for people. Really, every woman should discuss with her physician the risks of surgery, the benefits of the surgery, and alternatives, if there are other things that should be tried first, like medical management or other less invasive surgical procedures. It's really a personal thing to discuss with your physician.

The other thing that women need to discuss with their physician is whether to leave the ovaries in place versus removing the ovaries at the time of hysterectomy. And there are certain reasons, again, for and against that. And so women really need to have a personal detailed discussion with their physician regarding those options.

Would You Recommend da Vinci Surgery at Brookings Health System?

I would highly recommend Brookings Health System to women needing hysterectomy. We have a great OR staff who provide very personalized care. We have a great anesthesia team that, again, provides great, great care to patients. I think patients often get better care at some of the smaller facilities like Brookings Health System where you're a name and not a number.