Our Summary

This research paper conducted a survey among members of the International Society for Gynaecologic Endoscopy (ISGE) to understand their preferred methods for performing hysterectomies (a surgery to remove a woman’s uterus) and the barriers they face in offering minimally invasive hysterectomies (MIHs), which are surgeries with less pain and quicker recovery times.

The survey was completed by 159 members of ISGE, where 92% have been practicing for at least 5 years. When asked which method of hysterectomy they would prefer for themselves or their relatives, 59% chose the total laparoscopic method (done through small incisions in the abdomen), 19% preferred the vaginal method (done through the vagina), 8% chose the laparoscopically-assisted vaginal method (a mix of the first two methods), and 5% chose the total abdominal method (an open surgery through a large incision in the abdomen).

However, the survey found that the most commonly performed method was the total abdominal method, despite it being the least preferred. The main barriers to performing MIHs were a lack of training and experience. Only a quarter of the respondents had read the ISGE guidelines on performing vaginal hysterectomies.

The study concludes that, despite understanding the benefits of MIHs, the lack of training, experience, and knowledge of guidelines are leading to a high rate of total abdominal hysterectomies. The authors recommend more training on MIH techniques, continuous acquisition of practical experience, and the use of validated patient selection guidelines for MIHs.

FAQs

  1. What are the different methods of performing hysterectomies according to the survey among members of the International Society for Gynaecologic Endoscopy (ISGE)?
  2. What were the main barriers found in the survey that prevented surgeons from performing minimally invasive hysterectomies (MIHs)?
  3. What recommendations did the authors of the research paper make to increase the use of minimally invasive hysterectomies (MIHs)?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hysterectomy is to ask about minimally invasive options, such as laparoscopic or vaginal hysterectomy, as they typically result in less pain and quicker recovery compared to traditional abdominal hysterectomy. It’s important for patients to discuss with their doctor the benefits and risks of each type of hysterectomy to determine the best option for their individual situation.

Suitable For

Patients who are typically recommended hysterectomy include those with:

  1. Uterine fibroids that cause symptoms such as heavy menstrual bleeding, pelvic pain, or pressure on the bladder or bowel.
  2. Endometriosis that is severe and causing significant pain or affecting fertility.
  3. Adenomyosis, a condition where the tissue lining the uterus grows into the uterine wall, causing heavy periods and pelvic pain.
  4. Uterine prolapse, where the uterus slips down into the vaginal canal.
  5. Gynecologic cancers such as uterine, cervical, or ovarian cancer.
  6. Chronic pelvic pain that is not relieved by other treatments.
  7. Abnormal uterine bleeding that does not respond to other treatments.
  8. Severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) that significantly impacts quality of life.

It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine if hysterectomy is the best course of action for their specific condition.

Timeline

Before a hysterectomy, a patient will typically undergo various tests and evaluations to determine the need for the surgery. This may include a physical examination, imaging tests such as ultrasounds or MRIs, and blood tests. Patients may also be advised to try other treatments such as medication or less invasive procedures before proceeding with a hysterectomy.

After a hysterectomy, patients will experience a recovery period that can vary depending on the type of hysterectomy performed. Patients may need to stay in the hospital for a few days or go home the same day, depending on the procedure. Recovery can take several weeks, during which patients may experience pain, fatigue, and restrictions on activities such as lifting heavy objects or driving.

Over time, patients will start to feel better and resume their normal activities. They may also experience changes in their body such as menopause symptoms if the ovaries were removed during the hysterectomy. It is important for patients to follow their doctor’s instructions for post-operative care and attend follow-up appointments to monitor their recovery and overall health.

What to Ask Your Doctor

  1. What are the different types of hysterectomy procedures available, and which one do you recommend for me?
  2. What are the potential risks and complications associated with a hysterectomy?
  3. What is the recovery time expected for each type of hysterectomy procedure?
  4. Are there any alternative treatments or therapies I could consider before undergoing a hysterectomy?
  5. How will a hysterectomy impact my hormonal balance and menopausal symptoms?
  6. Will I still be able to have children or experience sexual pleasure after a hysterectomy?
  7. What is your experience and expertise in performing minimally invasive hysterectomies?
  8. What are the criteria for selecting patients for minimally invasive hysterectomies?
  9. What are the expected outcomes and benefits of a minimally invasive hysterectomy compared to a traditional abdominal hysterectomy?
  10. Are there any long-term effects or considerations I should be aware of post-hysterectomy?

Reference

Authors: Djokovic D, Noé G, van Herendael BJ, Chrysostomou A. Journal: Eur J Obstet Gynecol Reprod Biol. 2023 Dec;291:99-105. doi: 10.1016/j.ejogrb.2023.10.016. Epub 2023 Oct 15. PMID: 37857149