Our Summary

This study looked at trends in the types of hysterectomy surgeries performed at a major medical center and the rates of a complication called vaginal cuff dehiscence (VCD), where the top part of the vagina separates after a hysterectomy.

The researchers pulled data from over 4000 patients who had hysterectomies between 2010 and 2021. They found that the use of minimally invasive surgeries, like laparoscopic and robotic-assisted hysterectomies, increased significantly over this period.

They also looked at the rates of VCD for different types of surgeries. Overall, VCD was a rare complication, occurring in less than 1% of cases. They found that it was slightly more common in robotic and laparoscopic hysterectomies than in traditional abdominal hysterectomies, but the difference wasn’t statistically significant. This means that we can’t be sure if the slightly higher rates for the minimally invasive procedures are a true difference, or just due to chance because VCD is so rare.

The average time for VCD to occur was 39 days after surgery, and sexual intercourse was the most common trigger.

Overall, this study suggests that minimally invasive hysterectomy techniques are being used more often, and the rates of VCD are much lower than previously thought.

FAQs

  1. What is vaginal cuff dehiscence (VCD) and how common is it after a hysterectomy?
  2. Are there different rates of VCD between traditional abdominal hysterectomies and minimally invasive techniques like laparoscopic and robotic-assisted hysterectomies?
  3. Has the use of minimally invasive hysterectomy techniques increased over the past decade?

Doctor’s Tip

A helpful tip a doctor might give to a patient considering a hysterectomy is to discuss with their surgeon the different types of surgery options available, including minimally invasive techniques like laparoscopic or robotic-assisted hysterectomies. While VCD is a rare complication, it is important for patients to be aware of the potential risks and to follow their surgeon’s post-operative instructions carefully, including refraining from sexual intercourse until cleared by their doctor. It is also important to maintain open communication with their healthcare provider throughout the recovery process to address any concerns or complications that may arise.

Suitable For

Patients who may be recommended for hysterectomy include those with:

  1. Uterine fibroids that are causing symptoms such as heavy menstrual bleeding, pelvic pain, or pressure on surrounding organs.
  2. Endometriosis that is not responding to other treatments.
  3. Uterine prolapse, where the uterus descends into the vagina.
  4. Abnormal uterine bleeding that does not respond to other treatments.
  5. Gynecologic cancers such as cervical, uterine, or ovarian cancer.
  6. Chronic pelvic pain that is not responding to other treatments.
  7. Adenomyosis, a condition where the inner lining of the uterus grows into the muscle layer.
  8. Chronic pelvic inflammatory disease.
  9. Severe pelvic organ prolapse.

It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine if hysterectomy is the best option for their individual situation.

Timeline

Before hysterectomy:

  1. Patient consults with their healthcare provider to discuss reasons for needing a hysterectomy, risks and benefits, and alternative treatments.
  2. Patient undergoes pre-operative tests and evaluations to ensure they are healthy enough for surgery.
  3. Patient may have to undergo a period of preparation, such as stopping certain medications or fasting before surgery.
  4. Patient undergoes the hysterectomy surgery, which can be performed abdominally, vaginally, laparoscopically, or robotically.
  5. After surgery, patient is monitored in the hospital for a period of time before being discharged.
  6. Patient may experience pain, discomfort, and fatigue in the immediate post-operative period.
  7. Patient follows a recovery plan provided by their healthcare provider, including restrictions on activities, medications, and follow-up appointments.

After hysterectomy:

  1. Patient continues to recover at home, gradually increasing activity levels as advised by their healthcare provider.
  2. Patient may experience side effects such as vaginal bleeding, discharge, urinary incontinence, or changes in sexual function.
  3. Patient attends follow-up appointments with their healthcare provider to monitor healing and address any concerns.
  4. Patient may undergo hormone replacement therapy if the ovaries were also removed during the hysterectomy.
  5. Patient slowly resumes normal activities and may start physical therapy to improve strength and flexibility.
  6. Patient may need psychological support to cope with the emotional impact of losing their uterus.
  7. Patient eventually adjusts to life without a uterus, with potential benefits such as relief from symptoms like heavy menstrual bleeding or pelvic pain.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hysterectomy in light of this study include:

  1. What type of hysterectomy surgery do you recommend for me and why?
  2. What are the potential risks and complications associated with the different types of hysterectomy surgeries?
  3. What is the rate of vaginal cuff dehiscence (VCD) for the type of surgery you are recommending?
  4. How can I reduce my risk of developing VCD after surgery?
  5. What is the average recovery time for the type of hysterectomy surgery you are recommending?
  6. How soon after surgery can I resume sexual activity, and what precautions should I take to prevent VCD?
  7. What signs or symptoms should I watch out for that may indicate a complication like VCD?
  8. What follow-up care will be needed after the surgery to monitor for any complications?
  9. Are there any lifestyle changes or precautions I should take to improve my overall outcome after hysterectomy?
  10. Can you provide me with more information or resources about hysterectomy and potential complications like VCD?

Reference

Authors: Polin M, Boone R, Lim F, Advincula AP, May B, Hur C, Hur HC. Journal: J Minim Invasive Gynecol. 2023 Jul;30(7):562-568. doi: 10.1016/j.jmig.2023.03.005. Epub 2023 Mar 14. PMID: 36921892