Hysterectomy or less invasive options
There are now several different ways to perform a hysterectomy. Many techniques have been developed to decrease the invasiveness of the procedure and increase the speed of patient recovery.
Vaginal hysterectomy is an option that has been in practice for many years. Another option is laparoscopic assisted vaginal hysterectomy. In this technique, a tiny camera is used to look from above while the hysterectomy is performed from both an intra-abdominal and vaginal approach.
A robot can be used to assist in the hysterectomy. In this method, the doctor controls a robot, allowing the doctor the ability to use multiple ‘hands’ and different techniques within the same procedure. Robotic surgery allows for more precise movements that make it possible to perform the surgery through a small incision. This decreases the chances of infection and increases the speed of recovery.
Other Options Available
Other alternatives are available depending on the reasons for the hysterectomy.
Women with endometriosis that is not severe might be treatable with hormone therapy and surgery to remove the endometrial implants. Surgery can be performed laparoscopically, or in more extensive cases through traditional abdominal surgery. In laparoscopic surgery, a slender viewing instrument (laparoscope) is inserted through a small incision near the navel and small surgical instruments are inserted in another small incision to remove the endometrial implants.
Women with menorrhagia (heavy vaginal bleeding) should consider a surgical procedure to remove the uterine lining such as an endometrial ablation. This should be considered carefully because childbearing is not possible after the uterine lining is removed. Newer surgical methods like thermal balloon ablation, cryoablation, and radiofrequency ablation are all highly successful outpatient procedures normally performed in the doctor’s office. These procedures have lower complication rates and hospital stays than hysterectomies, and can be performed while determining the cause of the bleeding. If there is no underlying pathology and the source of the problem is vaginal bleeding, the ablation would be the only necessary treatment.
Some women qualify for embolization of their uterine artery. This is another outpatient or overnight procedure that can successfully make an actual hysterectomy unnecessary.
For patients who have a prolapsed uterus, severely enlarged fibroids or other underlying pathology, less invasive procedures may not be effective. However, there are still alternatives to an actual hysterectomy such as a supracervical hysterectomy in which the cervix is not removed. This decreases the chances of infection common to both laparoscopic assisted vaginal hysterectomies and robotic hysterectomies. It also decreases patient recovery time.
For women with uterine fibroids, and alternatives to a hysterectomy can be myomectomy, hysteroscopy, or uterine artery embolization (UAE), also known as uterine fibroid embolization (UFE).
Additional alternatives to a hysterectomy include:
- Abdominal trigger point injections (Injection of medicine into areas in the lower abdominal wall that are causing pain.)
- Antibiotics (If an infection is involved.)
- Biofeedback, relaxation exercises, and physical therapy
- Hormone therapy to stop ovulation
- Non-steroidal anti-inflammatory medications
- Psychological counseling
- In the end, a hysterectomy may be the best treatment. But with so many alternatives available, it is important to take the time to discuss all of your options with your doctor.
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