Our Summary

This study looked at the methods used for performing hysterectomies (removal of the uterus) in a large community health organization. More specifically, they examined the factors associated with the use of vaginal hysterectomy (VH), a procedure where the uterus is removed through the vagina.

They found that VH was performed in 13.3% of all hysterectomies. Patients who had given birth vaginally, were Hispanic, had normal uterus size, and showed signs of uterine descent were more likely to have a VH. Surgeons who performed more surgeries were also more likely to perform VH, and those with longer careers were more likely to perform VH than other types of hysterectomies.

Interestingly, 75% of patients who, according to the study’s criteria, should have had a VH, actually had a different type of hysterectomy. These patients had longer surgeries and more post-surgery complications. However, patients who had a VH even though they did not meet the criteria for it did not have more complications or blood loss than those who did meet the criteria.

The study suggests that the surgeon’s experience and the number of surgeries they perform could be factors in whether or not a VH is performed. The findings highlight the need to consider these factors when deciding on the type of hysterectomy to perform for each patient.

FAQs

  1. What percentage of hysterectomies performed in this study were vaginal hysterectomies (VH)?
  2. What factors were found to be associated with the use of vaginal hysterectomy?
  3. According to this study, how does the surgeon’s experience and number of surgeries performed influence the type of hysterectomy performed?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hysterectomy is to discuss with their surgeon the different types of hysterectomy available, including vaginal hysterectomy, and to inquire about the surgeon’s experience and expertise in performing each type. It is important for patients to understand the potential benefits and risks associated with each type of hysterectomy and to make an informed decision based on their individual circumstances and preferences.

Suitable For

Patients who may be recommended for a hysterectomy include those with conditions such as uterine fibroids, endometriosis, abnormal uterine bleeding, chronic pelvic pain, uterine prolapse, or gynecologic cancers such as cervical, ovarian, or uterine cancer. Patients who have not responded to other treatments, have severe symptoms impacting their quality of life, or have a family history of gynecologic cancers may also be recommended for a hysterectomy. Ultimately, the decision to undergo a hysterectomy is a personal one that should be made in consultation with a healthcare provider based on individual health needs and circumstances.

Timeline

  1. Consultation with healthcare provider: The patient meets with their healthcare provider to discuss their symptoms, medical history, and treatment options. The provider may recommend a hysterectomy as a treatment for conditions such as fibroids, endometriosis, or abnormal bleeding.

  2. Pre-operative preparation: The patient undergoes pre-operative tests, such as blood work and imaging studies, to ensure they are healthy enough for surgery. They may also be advised to stop taking certain medications or make lifestyle changes before the procedure.

  3. Surgery: The hysterectomy is performed, either through the abdomen (abdominal hysterectomy), vagina (vaginal hysterectomy), or using minimally invasive techniques such as laparoscopy or robotic-assisted surgery. The type of hysterectomy chosen depends on the patient’s condition, surgeon’s expertise, and other factors.

  4. Recovery: After the surgery, the patient stays in the hospital for a few days to recover. They may experience pain, discomfort, and fatigue during this time. The healthcare team will provide pain medication, monitor for any complications, and help the patient with mobility and self-care.

  5. Post-operative follow-up: The patient has follow-up appointments with their healthcare provider to monitor their recovery and address any concerns. They may also receive guidance on resuming normal activities, managing menopausal symptoms, and maintaining overall health after hysterectomy.

Overall, the patient’s experience before and after hysterectomy involves consultation, preparation, surgery, recovery, and follow-up care. The decision on the type of hysterectomy and the patient’s individual circumstances play a significant role in determining the outcomes and overall satisfaction with the procedure.

What to Ask Your Doctor

  1. What are the different types of hysterectomy procedures available, and why is vaginal hysterectomy (VH) being recommended for me?
  2. What are the potential risks and complications associated with VH compared to other types of hysterectomies?
  3. How experienced are you in performing VH, and how many VH procedures have you done in the past?
  4. What criteria are used to determine if I am a suitable candidate for VH?
  5. Are there any specific factors about my medical history or condition that make VH a better option for me?
  6. What is the recovery process like for VH compared to other types of hysterectomies?
  7. Will I have any limitations or restrictions after undergoing a VH?
  8. How will VH affect my future reproductive health and hormonal balance?
  9. Are there any alternative treatments or procedures that I should consider before deciding on a hysterectomy?
  10. Can you provide me with any additional resources or information to help me make an informed decision about undergoing a VH?

Reference

Authors: Buono K, Adams-Piper E, Gokhale K, Li Q, Guaderrama N, Whitcomb EL. Journal: J Minim Invasive Gynecol. 2021 Apr;28(4):881-890. doi: 10.1016/j.jmig.2020.08.004. Epub 2020 Aug 15. PMID: 32810604