More than one in four American women will have a hysterectomy by the
time they are 60 years old, according to the Centers for Disease Control
A hysterectomy—surgical removal of the uterus—can be a life-saving
operation for some women with certain types of cancer or excessive
uterine bleeding. It can also improve the quality of life for women who
experience abnormal uterine bleeding, uterine fibroids, endometriosis,
or uterine prolapse (the falling of the uterus from its normal position
into or outside of the vagina).
A hysterectomy is generally performed through an incision in the abdomen
or the vagina. During the procedure, the whole uterus or just part of it
may be removed. The fallopian tubes and ovaries may also be
There are now a variety of surgical techniques for performing
hysterectomies, which are discussed below. A physician and patient
should determine together the ideal surgical procedure based on her
particular medical history and the reason for surgery.
Approaches to Hysterectomy
The majority of hysterectomies are performed conventionally using an
“open” approach with a large incision in the abdomen. Another method is
a vaginal hysterectomy, which involves the removal of the uterus through
the vagina, without any external incision. Surgeons most often use this
preferred approach when the patient’s condition is benign and limited to
the uterus and when the uterus is normal size.
Today, there are a number of advanced options that feature shorter or no
hospital stays, less post-operative pain, negligible scars, and a quick
return to normal activity and work.
One such approach is laparoscopic or minimally invasive hysterectomy
where the uterus is removed using instruments, including a miniature
telescope and camera (laparoscope), inserted through several small
“keyhole” incisions in the abdomen.
Laparoscopically assisted vaginal hysterectomy allows the uterus (and
ovaries if necessary) to be removed through the vagina in cases that
otherwise would not be suited for a vaginal hysterectomy. This approach
has enabled a broader base of women to have the procedure done
vaginally, thus sparing a large abdominal incision. However, those who
have very large fibroids, certain types of cancer, or multiple previous
abdominal surgeries may not be appropriate candidates.
While the laparoscopic technique offers surgeons better visualization of
the uterus and surrounding area, it can limit their precision and
control due to the rigidity of the surgical instruments.
The da Vinci® robotic hysterectomy takes laparoscopic surgery to the
next level, giving surgeons unmatched precision, vision, and control.
The da Vinci hysterectomy is useful particularly when performing more
challenging procedures like hysterectomy with lymph node sampling for
gynecologic cancer and many of the surgeries that due to enlarged
fibroids or pelvic adhesions would be done with a large abdominal
incision. The potential benefits of robotic hysterectomy over
traditional approaches include less pain, minimal blood loss and
scarring, shorter hospital stay, and quicker recovery.
The robotic technique uses miniature instruments and a 3D camera
inserted through a few tiny incisions in the abdomen. The surgeon sits
at a nearby console to view a magnified, high-resolution, 3D image of
the uterus. The system then seamlessly translates the surgeon's hand,
wrist and finger movements into precise, real-time movements of surgical
instruments inside the patient. The system does not perform the surgery
– it simply enhances the surgeon’s skill through its precision.
While the da Vinci technology has revolutionized the approach to
hysterectomy, not to mention many other surgical procedures outside of
gynecology, it will take time before it appears in the offices of most
physicians. For many doctors who are used to working with their hands
and performing traditional surgeries, the da Vinci will present a new
set of challenges and requires specialized training and consistent use
But as the demand for more efficient and effective ways to perform
surgeries continues to increase, this approach may become more widely
available and could become the preferred method of doing most
Not all hysterectomy patients are candidates for the robotic approach.
The technique is especially well suited for obese patients, a modestly
enlarged uterus and/or ovaries, and for the dissection of lymph nodes in
the pelvis as part of cancer treatment.
As with any surgery, a hysterectomy is both patient- and
procedure-specific. Before making any final decision, it’s important to
be aware of and understand all the options available, as well as their
risks and benefits, and the physician’s experience using each technique.
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Women's Health Source
Women's Health Source
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Radnor, PA 19087
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