New Procedure Simplifies Laparoscopic Hysterectomy for Patients

By Nancy Kennedy

An innovative, state-of-the-art surgical technique is changing the way that many women experience hysterectomy – the surgical removal of the uterus. The minimally invasive “single-incision laparoscopic hysterectomy” is a relatively new surgical procedure that involves one small abdominal incision, placed at the umbilicus in such a way that the tiny post-operative scar is barely visible.
Laparoscopic surgery enables surgeons to perform major operations through minor incisions, through which they insert highly specialized instruments. The procedure has numerous advantages for the patient, says Malay Sheth, M.D., a Washington, PA OB-GYN physician who performs the surgery at The Washington Hospital.
“Patients who undergo this procedure have less pain, a faster recovery and a quicker return to their normal lifestyle,” says Sheth. “They’ll have a one-day hospital admission instead of several days. In general, a smaller incision is also safer, with a lower risk of complications.”
Hysterectomy is performed for both diagnostic and therapeutic purposes. Traditionally, the surgery has involved a large abdominal incision, considerable post-operative pain and a hospital stay of up to one week. But with the laparoscopic procedure, it has become an easier and nearly scarless operation.
In the U.S., one in three women over the age of 60 undergoes hysterectomy. It’s the second most commonly performed operation in the country, after C-sections. There are many medical indications for hysterectomy, including fibroids (benign tumors of the uterine wall); certain cancers; irregular bleeding; chronic pain; endometriosis; and recurrent abnormal Pap smears.
Sheth emphasizes that there are medical approaches to treating all of these conditions, before resorting to surgery, but if surgery is indicated, the single incision laparoscopic procedure is ideal for most patients. “If the uterus is very large, it may not be possible or advisable to remove it through this procedure. A traditional abdominal incision may be required. Also, for some types of ovarian and cervical cancers, this procedure is not recommended.
“It’s essential that a woman who is considering a hysterectomy for any reason talk with her doctor and consider all the alternatives. Not everyone is a candidate for this surgery.”
Laparoscopic hysterectomy is not in itself new; the procedure has been performed in American hospitals for the past two decades, utilizing three small incisions: three in the abdomen, and one in the top of the vagina.
The single-incision advance is made possible by technological advances, particularly a specially designed surgical instrument known as a port that enables the surgeon to insert a thin tube, with a light and tiny camera, to visualize the organ. Surgical instruments for removal of the uterus are also passed through the port.
Sheth explains that there are two versions of the procedure: a total hysterectomy, when the entire uterus, including the cervix, is being removed, a small vaginal incision is also made; and when it is only the uterus being removed, a single incision in the middle of the navel is all that is needed. That incision is just one-inch in length and often disappears into the navel as it heals, so that the cosmetic appearance of the abdomen is unaffected. It is also possible to remove the ovaries through single-incision surgery, with or without removing the uterus.
As far as risks, they are the same as for any surgery. Bleeding, infection and injury to the bladder or bowel are possible complications of hysterectomy, but are rare.

For more information about single-incision laparoscopic gynecological surgery or to make an appointment, you can reach Dr. Sheth at Washington OB-GYN Associates at (724) 225-3640. Washington OB-GYN has four office locations, in Washington, Charleroi, McMurray and Waynesburg. You can also visit
www.washingtonphysicians.org.

“Patients who undergo this procedure have less pain, a faster recovery and a quicker return to their normal lifestyle. They’ll have a one-day hospital admission instead of several days. In general, a smaller incision is also safer, with a lower risk of complications.”

-Dr. Malay Sheth

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