Our Summary

The classic vaginal hysterectomy, a surgical procedure to remove the uterus through the vagina, first performed in 1888, is now largely outdated due to painful incisions, high rates of urinary problems, and the inability to assess lymph nodes. However, some elements of this surgical method are still taught and practiced in certain medical centers. In the 1990s, French and German surgeons developed a combined vaginal and laparoscopic approach, using small incisions and a camera to guide the surgery. This method differs from laparoscopic radical vaginal hysterectomy (LARVH), another technique where the uterus is removed through the vagina with the help of laparoscopy.

After a study called the LACC trial explored the laparoscopic approach to cervical cancer, the radical vaginal approach has found new relevance. In fact, creating a “vaginal cuff” (closing off the vagina) before performing a laparoscopic hysterectomy can help prevent cancer cells from spreading during surgery. This could potentially improve the outcomes of minimally invasive surgeries for early-stage cervical cancer. Therefore, the combination of vaginal and laparoscopic surgical methods might be a promising direction for future research.

However, the vaginal surgical technique has been largely forgotten and requires specific training. Therefore, gynecological oncologists (doctors who specialize in treating cancers of the female reproductive system) should be well trained in creating a vaginal cuff.

FAQs

  1. Why is the classic vaginal hysterectomy considered outdated?
  2. What is the difference between the combined vaginal and laparoscopic approach and laparoscopic radical vaginal hysterectomy (LARVH)?
  3. Why is creating a “vaginal cuff” during a laparoscopic hysterectomy beneficial for early-stage cervical cancer patients?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hysterectomy is to make sure to ask about all available surgical options and discuss the potential risks and benefits of each approach. It’s important to have a thorough discussion with your doctor to ensure you are well informed and comfortable with the chosen surgical method. Additionally, following your doctor’s post-operative care instructions and attending follow-up appointments are crucial for a successful recovery.

Suitable For

Patients who may be recommended for a hysterectomy include those with:

  1. Gynecological cancers such as cervical, uterine, or ovarian cancer
  2. Severe endometriosis
  3. Uterine fibroids causing significant symptoms such as heavy bleeding or pelvic pain
  4. Chronic pelvic inflammatory disease
  5. Chronic pelvic pain that has not responded to other treatments
  6. Adenomyosis (a condition where the lining of the uterus grows into the muscle wall)
  7. Prolapse of the uterus or other pelvic organs
  8. Severe uterine bleeding that does not respond to other treatments

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

Timeline

Before a hysterectomy, a patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, fibroids, endometriosis, or cancer. They will likely undergo various tests and consultations with their healthcare provider to determine if a hysterectomy is the best course of action.

After the decision is made to proceed with a hysterectomy, the patient will undergo pre-operative preparations such as blood tests, imaging scans, and discussions with their healthcare team about the procedure. They may also need to make arrangements for post-operative care and recovery.

During the hysterectomy surgery, the patient will be under anesthesia and the surgeon will remove the uterus. The specific method of hysterectomy (vaginal, laparoscopic, abdominal) will depend on various factors such as the reason for the surgery, the patient’s medical history, and the surgeon’s expertise.

After the surgery, the patient will typically stay in the hospital for a few days for monitoring and pain management. They will need to follow post-operative care instructions such as taking pain medication, avoiding heavy lifting, and attending follow-up appointments with their healthcare provider.

In the weeks and months following a hysterectomy, the patient may experience physical and emotional changes as they recover. They may need to adjust to life without a uterus, manage symptoms such as menopause, and address any concerns or complications that may arise.

Overall, the timeline of a patient’s experience before and after a hysterectomy can vary depending on individual circumstances, but the goal is to improve their quality of life and address any underlying health issues.

What to Ask Your Doctor

  1. What type of hysterectomy procedure do you recommend for my specific condition?
  2. What are the potential risks and complications associated with the type of hysterectomy you are recommending?
  3. How long is the recovery process for this type of hysterectomy?
  4. Will I experience any long-term effects or changes in my body after the hysterectomy?
  5. Will I still be able to have children after the hysterectomy?
  6. How will the hysterectomy affect my hormone levels and menopausal symptoms?
  7. Will I need to take hormone replacement therapy after the hysterectomy?
  8. What are the potential alternatives to hysterectomy for my condition?
  9. How many hysterectomies have you performed using this specific surgical technique?
  10. What is the success rate of this type of hysterectomy for my condition?

Reference

Authors: Querleu D, Hudry D, Narducci F, Rychlik A. Journal: Curr Treat Options Oncol. 2022 Feb;23(2):227-239. doi: 10.1007/s11864-022-00937-5. Epub 2022 Feb 23. PMID: 35195838