You might be surprised to learn that hysterectomy, the surgical removal of the uterus, is the most common gynecologic surgical procedure performed in the United States. With 600,000 performed annually, they are the most common surgery women undergo, after cesarean section, and by the age of 85, 43 percent of women will have had their uterus surgically removed. So, what should you know about this common procedure that accounts for a whopping five billion health care dollars per year?
Most hysterectomies are performed prior to menopause, and only 10 percent of hysterectomies are performed for cancer. The most common indications for hysterectomies are uterine fibroids, benign muscle tumors of the uterus; endometriosis, the presence of endometrial glands outside of the uterus; and pelvic organ prolapse, which occurs when internal organs drop from their original position.
Traditionally, hysterectomies were performed via laparotomy, a large abdominal incision, which has a high complication rate and often requires several nights in the hospital and six weeks or more for recovery. Today, hysterectomies can be accomplished in a minimally invasive fashion through vaginal, laparoscopic, or robotic techniques, sometimes requiring no hospital stay at all and as little as two weeks’ recovery. The American Congress of Obstetricians and Gynecologists (ACOG), the guiding organization for obstetricians and gynecologists in the United States, recommends that all hysterectomies be performed through vaginal or laparoscopic methods whenever possible, due to the lower complication rate and faster recovery time.
These surgical methods provide the patient with the least amount of pain, blood loss, and time spent in the hospital. In fact, a national survey of obstetricians and gynecologists found that over 90 percent would prefer a vaginal or laparoscopic hysterectomy for themselves or their spouses. Unfortunately, nearly two-thirds of hysterectomies are still performed via a laparotomy, despite these recommendations and technological advances in surgical technique. The most common reasons cited for not performing vaginal or laparoscopic hysterectomy include lack of training, lack of surgeon experience and perceived difficulty of the case. If you are planning to undergo a hysterectomy, ask your physician if the procedure can be performed vaginally or laparoscopically, and if not, request a second opinion.