Our Summary

This study looked at how the use of different types of laparoscopic hysterectomy (a less invasive surgery to remove the uterus) changed after the US Food and Drug Administration (FDA) issued a warning about a technique called power morcellation in 2014. The research analyzed data from over 145,000 women who had a hysterectomy for non-cancerous reasons between 2012 and 2016.

The study found that after the FDA’s warning, the use of one type of laparoscopic hysterectomy (laparoscopic supracervical hysterectomy) decreased significantly. However, the use of total laparoscopic hysterectomy did not change. Over time, the overall use of laparoscopic hysterectomy started to increase again. Also, the time taken to perform the laparoscopic supracervical hysterectomy increased by about 11 minutes after the FDA warning. Additionally, the trend of more patients having this surgery as an outpatient (and less as an inpatient) slowed down after the warning.

However, there was no significant change in the rate of complications within 30 days of the surgery after the FDA warning. In other words, the warning did not seem to impact patient outcomes. The decrease in the use of laparoscopic supracervical hysterectomy is likely related to the safety concerns raised in the FDA warning about power morcellation.

FAQs

  1. What impact did the FDA’s warning about power morcellation have on the use of different types of laparoscopic hysterectomy?
  2. Did the FDA’s warning about power morcellation affect the rate of complications within 30 days of the surgery?
  3. After the FDA’s warning, was there a change in the amount of time taken to perform the laparoscopic supracervical hysterectomy?

Doctor’s Tip

Based on this study, a doctor might advise a patient considering a hysterectomy to discuss the different types of laparoscopic hysterectomy options available and the potential risks and benefits of each. They may also recommend considering the long-term outcomes and recovery time associated with each type of surgery. It’s important for patients to have open and honest conversations with their healthcare provider to make an informed decision about their treatment plan.

Suitable For

Patients who may be recommended for hysterectomy include those with conditions such as:

  • Uterine fibroids that cause symptoms such as heavy menstrual bleeding, pelvic pain, or pressure on the bladder or bowels
  • Endometriosis
  • Adenomyosis
  • Uterine prolapse
  • Abnormal uterine bleeding
  • Chronic pelvic pain
  • Pelvic inflammatory disease
  • Gynecologic cancers such as uterine, ovarian, or cervical cancer

Ultimately, the decision to undergo a hysterectomy is based on the specific condition, severity of symptoms, patient preferences, and overall health status. It is important for patients to discuss the risks and benefits of hysterectomy with their healthcare provider to determine the most appropriate treatment option for their individual situation.

Timeline

Before the hysterectomy:

  • Patient may experience symptoms such as heavy or abnormal menstrual bleeding, pelvic pain, or fibroids
  • Patient consults with their gynecologist to discuss treatment options
  • Gynecologist may recommend a hysterectomy as a last resort if other treatments have been unsuccessful
  • Patient undergoes pre-operative tests and evaluations to ensure they are a candidate for surgery
  • Patient discusses the risks and benefits of the surgery with their healthcare provider

After the hysterectomy:

  • Patient undergoes the surgery, which may be performed using different techniques such as laparoscopic, abdominal, or vaginal
  • Patient stays in the hospital for a few days to recover, depending on the type of surgery
  • Patient may experience some pain, discomfort, and fatigue after the surgery
  • Patient follows post-operative instructions provided by their healthcare provider, such as avoiding heavy lifting and physical activity for a certain period of time
  • Patient attends follow-up appointments to monitor their recovery and address any concerns or complications
  • Patient may experience improvements in their symptoms, such as relief from pelvic pain or heavy bleeding
  • Patient may also experience changes in their hormonal balance and emotions after the surgery
  • Patient may need to adjust to the physical and emotional changes that come with the removal of their uterus

What to Ask Your Doctor

  1. What are the different types of hysterectomy procedures available, and which one do you recommend for my specific condition?

  2. Can you explain the risks and benefits of each type of hysterectomy procedure, including laparoscopic hysterectomy?

  3. How will the FDA warning about power morcellation affect my decision for a hysterectomy procedure?

  4. What steps will be taken to ensure the safety of the procedure, particularly in regards to the concerns raised in the FDA warning?

  5. How long will the recovery process be for the recommended hysterectomy procedure?

  6. Are there any alternative treatments to consider before opting for a hysterectomy?

  7. What are the potential long-term effects of a hysterectomy on my overall health and well-being?

  8. How many hysterectomy procedures have you performed, and what is your success rate?

  9. Will I need to follow any specific post-operative care instructions after the surgery?

  10. Are there any specific lifestyle changes or precautions I should take after a hysterectomy procedure?

Reference

Authors: Desai VB, Wright JD, Lin H, Gross CP, Sallah YH, Schwartz PE, Xu X. Journal: Obstet Gynecol. 2019 Aug;134(2):227-238. doi: 10.1097/AOG.0000000000003375. PMID: 31348209