Our Summary

This research paper examines how the surgical approach to hysterectomies (a procedure to remove a woman’s uterus) in the U.S. changed after the Food and Drug Administration (FDA) issued a warning about a technique called power morcellation. This technique, used during minimally invasive surgery, was flagged for safety concerns.

The researchers used data from a national program that tracks surgical quality from 2012 to 2016. They found that laparoscopy (a type of minimally invasive surgery) remained the most common way to perform a hysterectomy throughout this period.

Before media reports and the FDA warning about power morcellation, the use of abdominal hysterectomies (a more invasive form of surgery) did not significantly change. However, after these events, the use of abdominal hysterectomies slightly increased for a short period, then plateaued, and finally decreased by the end of 2016.

The volume of supracervical hysterectomies (where the cervix is left in place) continuously decreased after the FDA warning. These procedures that were still being performed were more likely to be done using traditional surgery (laparotomy) rather than minimally invasive techniques.

In conclusion, while it was initially thought that the FDA warning would cause a significant decrease in the use of minimally invasive hysterectomies, the researchers found that this was not the case in the long term. Meanwhile, the number of supracervical hysterectomies did decrease, with more of these operations being done using traditional surgical methods.

FAQs

  1. What is power morcellation and why was it flagged by the FDA?
  2. How did the FDA warning on power morcellation affect the use of abdominal and supracervical hysterectomies?
  3. Did the FDA warning lead to a significant decrease in the use of minimally invasive hysterectomies in the long term?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hysterectomy is to discuss all available surgical options and their associated risks and benefits before making a decision. It’s important to be informed and have a clear understanding of what to expect before undergoing surgery. Additionally, it’s important to follow post-operative care instructions and attend follow-up appointments to ensure a smooth recovery.

Suitable For

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

  1. Uterine fibroids: Women who have large fibroids that are causing symptoms such as heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel may be recommended for a hysterectomy.

  2. Endometriosis: Women with severe endometriosis that has not responded to other treatments may be recommended for a hysterectomy to remove the uterus and ovaries.

  3. Uterine prolapse: Women with severe uterine prolapse, where the uterus descends into the vaginal canal, may be recommended for a hysterectomy to correct the problem.

  4. Gynecologic cancers: Women with gynecologic cancers such as uterine, cervical, or ovarian cancer may be recommended for a hysterectomy as part of their treatment plan.

  5. Chronic pelvic pain: Women with chronic pelvic pain that does not respond to other treatments may be recommended for a hysterectomy as a last resort.

  6. Adenomyosis: Women with adenomyosis, a condition where the tissue that lines the uterus grows into the uterine wall, may be recommended for a hysterectomy if symptoms are severe.

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

Timeline

Overall, the timeline of a patient’s experience before and after hysterectomy may look like this:

  • Before the FDA warning and media reports about power morcellation: The patient may undergo discussions with their healthcare provider about their options for hysterectomy, including the different surgical approaches available. They may choose a minimally invasive laparoscopic hysterectomy or a more traditional abdominal hysterectomy. The surgery is performed, and the patient goes through the recovery process, which may involve some pain and discomfort.

  • After the FDA warning and media reports about power morcellation: The patient may be informed about the safety concerns surrounding power morcellation and the potential risks associated with this technique. They may have discussions with their healthcare provider about the best approach for their hysterectomy, taking into account the new information. The patient may undergo a different type of surgery, such as an abdominal hysterectomy rather than a laparoscopic one, to avoid the risks associated with power morcellation. The recovery process may be slightly different, with potentially longer healing times and increased pain compared to minimally invasive surgery.

Overall, the timeline of a patient’s experience before and after hysterectomy can be influenced by factors such as new safety information, changes in surgical practices, and individual patient preferences. It is important for patients to have open and honest discussions with their healthcare providers to ensure they receive the best possible care for their specific situation.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hysterectomy include:

  1. What are the different types of hysterectomy procedures available, and which one do you recommend for my specific condition?
  2. What are the potential risks and complications associated with the hysterectomy procedure?
  3. How long is the recovery time after the surgery, and what can I expect during the recovery process?
  4. Will my fertility be affected by the hysterectomy, and are there any alternative treatments to consider before proceeding with surgery?
  5. What are the potential long-term effects of having a hysterectomy, such as hormonal changes or pelvic floor issues?
  6. How often do you perform hysterectomy procedures, and what is your experience with the specific type of surgery recommended for me?
  7. Are there any specific guidelines or restrictions I need to follow before and after the surgery to ensure a successful outcome?
  8. Will I need to take any medications or undergo any additional tests before the surgery?
  9. What are the chances of needing additional surgeries or treatments in the future after having a hysterectomy?
  10. How will the hysterectomy affect my overall quality of life, including physical and emotional well-being?

Reference

Authors: Jorgensen EM, Modest AM, Hur HC, Hacker MR, Awtrey CS. Journal: Obstet Gynecol. 2019 Apr;133(4):643-649. doi: 10.1097/AOG.0000000000003181. PMID: 30870280