Our Summary

This research paper looks at how the methods and frequency of performing hysterectomies (surgery to remove the uterus) have changed among ob-gyn residents in the U.S. over time. The researchers analyzed data from 2002 to 2018 and found that fewer residents are performing this surgery overall. When it comes to the methods used, they found that fewer residents are performing the surgery through the abdomen or vagina, but more are using a method called laparoscopic hysterectomy, where small incisions are made in the abdomen and a camera is used to guide the procedure. The increase in laparoscopic hysterectomies is notable despite the overall decrease in the number of these surgeries.

FAQs

  1. How has the frequency of hysterectomies performed by ob-gyn residents in the U.S. changed from 2002 to 2018?
  2. What changes have been observed in the methods used for performing hysterectomies over the years?
  3. Despite the overall decrease in hysterectomies, why is there an increase in laparoscopic hysterectomies?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hysterectomy is to discuss with their healthcare provider the different methods of hysterectomy available and which one may be most suitable for their individual situation. It is important for patients to understand the potential risks and benefits of each method and to ask any questions they may have before making a decision. Additionally, patients should follow their doctor’s post-operative care instructions closely to ensure a smooth recovery.

Suitable For

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

  1. Severe or chronic pelvic pain: Hysterectomy may be recommended for patients who experience severe or chronic pelvic pain that does not respond to other treatments.

  2. Uterine fibroids: Large or multiple uterine fibroids that cause symptoms such as heavy menstrual bleeding, pelvic pain, or pressure may be treated with a hysterectomy.

  3. Endometriosis: Severe endometriosis that does not respond to other treatments may be treated with a hysterectomy.

  4. Uterine prolapse: In cases of severe uterine prolapse where the uterus descends into the vagina, a hysterectomy may be recommended.

  5. Abnormal uterine bleeding: Patients with abnormal uterine bleeding that does not respond to other treatments may be recommended for a hysterectomy.

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

  7. Adenomyosis: Severe adenomyosis, a condition where the inner lining of the uterus grows into the muscle wall, may be treated with a hysterectomy.

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

Timeline

Before hysterectomy:

  1. Patient discusses symptoms with their doctor and explores non-surgical treatment options.
  2. Patient undergoes various tests and evaluations to determine if a hysterectomy is necessary.
  3. Patient and doctor discuss the different types of hysterectomy procedures and choose the best option for the patient’s specific situation.
  4. Patient prepares for surgery by following pre-operative instructions, such as fasting and stopping certain medications.
  5. Patient undergoes the hysterectomy procedure, which can be done abdominally, vaginally, laparoscopically, or robotically.

After hysterectomy:

  1. Patient spends time recovering in the hospital or at home, depending on the type of hysterectomy performed.
  2. Patient experiences physical discomfort and fatigue as they heal from the surgery.
  3. Patient may need to take pain medication and follow a restricted activity plan for several weeks.
  4. Patient follows up with their doctor for post-operative care and monitoring.
  5. Patient may experience changes in their body, such as menopausal symptoms or changes in sexual function.
  6. Patient adjusts to life without a uterus and manages any emotional or psychological effects of the surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a hysterectomy?
  2. Are there alternative treatments or procedures that could be considered instead of a hysterectomy?
  3. How will a hysterectomy impact my hormonal balance and menopausal symptoms?
  4. What is the recovery process like after a hysterectomy and how long can I expect to be out of work or normal activities?
  5. Will a hysterectomy affect my ability to have children in the future?
  6. What type of hysterectomy procedure do you recommend for my specific condition?
  7. How experienced are you in performing hysterectomies and what is your success rate?
  8. Are there any long-term effects or considerations I should be aware of after having a hysterectomy?
  9. How will a hysterectomy impact my sexual function and libido?
  10. Are there any lifestyle changes or precautions I should take before and after the surgery to optimize my recovery?

Reference

Authors: Gressel GM, Potts JR 3rd, Cha S, Valea FA, Banks E. Journal: Obstet Gynecol. 2020 Feb;135(2):268-273. doi: 10.1097/AOG.0000000000003637. PMID: 31923067