(This is second in my series of my blogs associated with Hysterectomy. In my previous blog, I had covered the basics – as to when is hysterectomy needed)
An important question in Hysterectomy is to determine the route which needs to be taken for the surgery. Some of the common consideration points to be considered before deciding on any route of surgery are –
- What are the surgical options available? Pros and cons of each.
- Which is the safest route/option with a minimal recovery period?
- Which route has a pain free and a comfortable post surgery period, a short hospital stay, a quick rollback into the routine activities?
- And of course which option is pocket friendly?
Let me try to compare the options available based along the points listed above.
Hysterectomy conventionally can be done by three ways depending upon the clinical situation of the patient and the experience of the surgeon.
- Abdominal route (Abdominal hysterectomy) – This is the age old and traditional method of removing the uterus. Hysterectomy is done by opening up the lower abdomen by a horizontal or a vertical incision. Since there is an incision on the abdomen, the recovery is slow in this route as compared to other routes. Also there is always a possibility of potential complications of wound infection, pain, or a hernia. In addition, this method also leaves an impression (scar) behind on the abdomen. In today’s era of minimally invasive surgery, this route has now started taking a backseat, lest one needs to tackle a complicated problem or more than one pathology at the same time.
- Laparoscopic (Endoscopic) Approach – Laparoscopic Hysterectomy – In this method about an inch long incision is given on or just below the umbilicus. Three to four stab incisions are made on either side of this main port for instrumentation. With the use of various modalities of heating and cutting devices, uterus is freed of its ligaments and attachments and finally removed through the vagina. Though endoscopy has revolutionized the approach to many surgical procedures, this route for hysterectomy in my personal opinion is still a tedious route. Time required for the surgery is much more, requires prolonged anesthesia, naturally adding to the potential complications of it. Besides there can be thermal injuries to the intestines or the ureter and the urinary bladder. This also is the costliest of all routes.
- Vaginal route – Vaginal Hysterectomy – In my opinion this is the best route – a scar less surgery in the truest sense. By this method the entire uterus is removed by the vaginal route, so there are no scar or stab incisions on the abdomen. The surgery is over within 30 to 45 mins, with a negligible blood loss. As a patient, you can start on oral diet within 4 – 6 hrs and can be up in about 8 – 10 hrs. Very comfortably you can get also get a discharge from the hospital within 18 to 24 hours of surgery. You can resume your routine activities within couple of days. The post operative period is comfortable and generally pain free. Since there are no scars or the use of a laparoscope, there is no question of the complications associated with these routes. Except for a rare post operative bleeding (which can occur in any of the above routes) there are hardly any complications by vaginal route which can be enumerated.
The ultimate aim of the advances in the field of medicine and surgery is for the betterment of the human kind. However, it is also important that they are applied rationally and for particular proper conditions. Though endoscopy is the modern day surgical tool, yet as I mentioned earlier, in my opinion vaginal route for hysterectomy (and also has been proved by countless literature) is far better to any of the other routes. Of course as in any medical practice there are always scenarios where it should or cannot be done. For example, in surgeries of genital tract cancers or in cases where other abdominal pathologies exist, or patients with huge fibroids – vaginal hysterectomy may just not be advisable.
Hope this blog gives you a good overview of the options available for hysterectomy and the pros and cons of each. As usual, if you would have any questions/thoughts, please feel to reach out to me or post a question on this blog.
In my next blog, I will cover some of the common questions/inhibitions which I have heard about hysterectomy and my thoughts around that.
