Our Summary

This research paper is a review of studies comparing two types of hysterectomy surgeries: total laparoscopic hysterectomy (TLH) and vaginal hysterectomy (VH). A hysterectomy is a procedure to remove a woman’s uterus. The researchers looked at studies conducted between 2000 and 2016 to compare the outcomes of these two methods.

The results showed that there was no significant difference between the two types of surgeries in terms of complications, risk of injuries to the bladder and the tubes that carry urine from the kidneys to the bladder, blood loss during surgery, and the length of hospital stay. However, the vaginal hysterectomy (VH) had a few advantages. It took less time, had a lower risk of the vaginal cuff (the upper part of the vagina that’s closed off during a hysterectomy) opening up, and less chance of needing to switch to an open surgery (laparotomy). The costs for VH were also lower.

On the other hand, patients who underwent the total laparoscopic hysterectomy experienced less post-surgery pain and required less pain relief.

The researchers conclude that, although both methods have similar outcomes, the vaginal hysterectomy currently has more advantages. However, they also note that the best surgical method can change as techniques improve. The choice of method should be a shared decision between the patient and doctor, considering many factors.

FAQs

  1. What are the two types of hysterectomy surgeries compared in this research paper?
  2. What advantages were found for vaginal hysterectomy compared to total laparoscopic hysterectomy?
  3. How does the pain experience differ between patients who underwent total laparoscopic hysterectomy and those who had a vaginal hysterectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hysterectomy is to discuss the potential advantages and disadvantages of different surgical methods, such as total laparoscopic hysterectomy and vaginal hysterectomy, and to make a decision based on individual factors and preferences. It is important to have an open and honest conversation with your healthcare provider to determine the best option for your specific situation. Additionally, following your doctor’s post-operative instructions and attending follow-up appointments is crucial for a successful recovery.

Suitable For

Patients who are typically recommended for a hysterectomy include those with:

  1. Uterine fibroids: Non-cancerous growths in the uterus that can cause heavy menstrual bleeding, pelvic pain, and other symptoms.

  2. Endometriosis: A condition where the tissue that lines the uterus grows outside of it, causing pain and other symptoms.

  3. Uterine prolapse: When the uterus slips down into the vaginal canal due to weakened pelvic muscles.

  4. Abnormal uterine bleeding: Heavy or irregular menstrual bleeding that does not respond to other treatments.

  5. Gynecologic cancers: Hysterectomy may be recommended as part of treatment for cancers such as uterine, cervical, or ovarian cancer.

  6. Chronic pelvic pain: Severe, ongoing pain in the pelvic region that does not respond to other treatments.

  7. Adenomyosis: A condition where the tissue that lines the uterus grows into the muscular wall, causing pain and heavy menstrual bleeding.

  8. Pelvic inflammatory disease: Infections of the female reproductive organs that can cause scarring and damage.

It is important for patients to discuss their individual situation and medical history with their healthcare provider to determine if a hysterectomy is the best treatment option for them.

Timeline

Before hysterectomy:

  • Patients may experience symptoms such as heavy menstrual bleeding, pelvic pain, fibroids, endometriosis, or other conditions that require the removal of the uterus.
  • Patients may undergo various diagnostic tests such as pelvic exams, ultrasounds, MRI, or blood tests to determine the need for a hysterectomy.
  • Patients may explore non-surgical treatment options such as medication or other therapies before deciding to undergo a hysterectomy.
  • Patients may have consultations with their gynecologist or surgeon to discuss the procedure, risks, benefits, and recovery process.

After hysterectomy:

  • Patients will have a recovery period that typically lasts 4-6 weeks, during which they may experience pain, fatigue, and limitations on physical activities.
  • Patients will need to follow post-operative instructions such as taking pain medication, avoiding heavy lifting, and refraining from sexual activity for a certain period of time.
  • Patients may experience changes in hormone levels and menstrual cycles, especially if the ovaries are removed during the hysterectomy.
  • Patients may experience emotional and psychological effects such as grief, loss of fertility, or changes in body image.
  • Patients will have follow-up appointments with their gynecologist or surgeon to monitor their recovery and address any concerns or complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with each type of hysterectomy surgery?
  2. How long is the recovery time for each type of surgery and what can I expect during the recovery process?
  3. Will I be able to have children after undergoing a hysterectomy?
  4. How will each type of surgery impact my hormonal balance and overall health in the long-term?
  5. Are there any specific factors that make me a better candidate for one type of surgery over the other?
  6. What are the potential long-term effects of each type of surgery on my sexual health and bladder function?
  7. How many of these surgeries have you performed and what is your success rate with each type?
  8. Will I need to take hormone replacement therapy after the surgery and if so, for how long?
  9. What are the costs associated with each type of surgery, including any potential additional expenses or follow-up care?
  10. Are there any alternative treatments or procedures that I should consider before deciding on a hysterectomy?

Reference

Authors: Sandberg EM, Twijnstra ARH, Driessen SRC, Jansen FW. Journal: J Minim Invasive Gynecol. 2017 Feb;24(2):206-217.e22. doi: 10.1016/j.jmig.2016.10.020. Epub 2016 Nov 17. PMID: 27867051