Erin Carey, MD, division director of minimally invasive gynecologic surgery with the UNC Department of Obstetrics and Gynecology, talks to us about a scarless, laparoscopic approach to hysterectomy that works well for most women.
What is a hysterectomy?
Hysterectomy is a surgical procedure in which a woman’s uterus is removed. We may also remove some of the surrounding structures, such as the fallopian tubes or the cervix.
A total hysterectomy removes the uterus and cervix. A subtotal hysterectomy is just the top portion of the uterus, the corpus. Those are the most common types.
Nearly all of the hysterectomies that we do here at UNC are done laparoscopically… Once the incision heals, there usually isn’t even a scar.
Nearly all of the hysterectomies that we do here at UNC are done laparoscopically—approximately 5 mm incisions. Recently we began using percutaneous instruments to make an incredibly small incision—2.9 mm—and remove what we need to through that tiny opening. Once the incision heals, there usually isn’t even a scar.
Almost any size of uterus or pelvic pathology can be done in this way, and we are the only ones in North Carolina able to offer this microlaparoscopic approach to hysterectomies.
Who is a good candidate for a hysterectomy?
Women have hysterectomies for a variety of reasons, but the two most common causes are bleeding or pain—most commonly painful, heavy periods, endometriosis or uterine fibroids.
When someone comes to us for a surgical evaluation, we make sure they’ve exhausted all nonsurgical options first, because that is the safest thing for the patient. If she has tried and failed those options, has completed childbearing or doesn’t want to have any children, we can start talking about hysterectomy.
Almost all the women we consult with for hysterectomy are candidates for a minimally invasive, laparoscopic approach. We can remove uteri as large as basketballs through small incisions.
How safe is the hysterectomy procedure?
Hysterectomy is very safe. All surgery has risk—most commonly bleeding and infection. The benefit of our laparoscopic approach is that those risks are significantly reduced when compared with the open abdominal incision that used to be the common approach.
For the laparoscopic surgeries that we perform at UNC Medical Center, most of our patients go home the same day. This is something that patients get really excited about.
A minimally invasive approach means there is less tissue injury during the surgery, which decreases the stress the surgery causes to the body, making the hysterectomy easier to recover from.
A minimally invasive approach means there is less tissue injury during the surgery, which decreases the stress the surgery causes to the body, making the hysterectomy easier to recover from.
We have recovery protocols in place for each patient who has major surgery. For example, our anesthesiologists provide patients with medications to take before surgery that help lessen the pain they might feel later. Before we instituted these processes, our patients were already going home the same day, but we are changing how they feel when they go home. The outcomes are remarkable.
What is recovering from a hysterectomy like?
The postoperative window is six weeks. Even if you go home the same day, it’s still a major surgical procedure. We usually have patients come in for a follow-up visit about four to six weeks after their hysterectomy procedure.
As long as there is no fever or heavy bleeding—which could indicate a more serious problem—I have two big rules for women after having a hysterectomy.
The first is no lifting anything heavier than 10 pounds for the first six weeks. That’s because even though they have a tiny incision in their abdomen, they have a larger incision at the top of their vagina where the cervix used to be. It’s an incision that they can’t see, and we want to make sure that it heals well.
The second rule is nothing in the vagina for eight weeks after surgery. When we see the patient back at the four- to six-week mark, we are able to let them know if they will be able to resume penetrative sex at eight weeks.
Patients who have a subtotal hysterectomy—those who don’t have their cervix removed—don’t have these restrictions.
What are some other advantages of laparoscopic hysterectomy?
I’m a huge advocate of the idea that if you need surgery, then you need to have it done in a minimally invasive manner, if you can.
For the laparoscopic surgeries that we perform at UNC, most of our patients go home the same day. This is something that patients get really excited about.
Surgery risks like infection, postoperative pain and chronic postsurgical pain—pain that outlasts the initial tissue injury—can all be greatly reduced through a laparoscopic approach. These women are able to go home with less pain and get back to their daily activities more quickly.
Learn more about minimally invasive gynecologic surgery at UNC Medical Center.