FOCUS: HYSTERECTOMY

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

4. ? WHAT IS A HYSTERECTOMY

5. HYSTERECTOMY:THE SURGICAL REMOVAL OF THE UTERUS

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 • Over 65% of hysterectomies are still performed through an abdominal incision ( TAH )

11. ? ARE THERE DIFFERENTTYPES OF HYSTERECTOMY

12. 3 HYSTERECTOMY TYPES Total Hysterectomy Subtotal Hysterectomy Radical Hysterectomy

13. TOTAL HYSTERECTOMY: SURGICAL REMOVAL OF THE UTERUS &CERVIX

14. SUBTOTAL HYSTERECTOMY: SURGICAL REMOVAL OF THE UTERUS LEAVINGTHE CERVIX IN PLACE

15. RADICAL HYSTERECTOMY: SURGICAL REMOVAL OF THE UTERUS,CERVIX, AND PELVICLYMPH 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 DOCTORRECOMMENDED HYSTERECTOMY

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

20. ? HOW WILL MY DOCTORPERFORM THE HYSTERECTOMY

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

22. 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

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

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

31. LAPAROSCOPIC HYSTERECTOMY First LH perfomed in 1989 • Newest approach to hysterectomy Use a Laparoscope to see inside of abdomen Laparoscopic instruments are inserted Into3-4 half inch incisions in abdomen • ONLY 10 -11% 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 LaparoscopicHysterectomy 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 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 & DISADVANTAGESOF TAH, VH, & LH

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

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