When a woman’s doctor recommends a hysterectomy, one of her first questions should be "what kind of hysterectomy," advised Maxine Lingurar, M.D. Gone are the days of one-size fits all.
Dr. Lingurar, whose gynecology practice is at the Women’s Health Center in St. Rose Ambulatory & Surgery Center, notes that in most cases, the minimally invasive outpatient surgeries she performs are the best routes.
In more complex cases, a surgeon may suggest an abdominal operation that could be performed with or without new robotic technology.
"The robot is a great tool for extremely complex hysterectomies, including those for large fibroid tumors, cancer, pelvic support problems or severe endometriosis," Dr. Lingurar said. "When necessary, we will refer the patient to another facility for this robotic operation."
However, Dr. Lingurar added, robotic surgery is "extremely expensive" and in most cases unnecessary.
"From a public health perspective, we don’t want to drive up the cost of everyone’s health care when it is not necessary," Dr. Lingurar said. "In the case of hysterectomies, minimally invasive procedures are not only the best way to treat most women, they are also much more cost effective."
Minimally invasive hysterectomies include those that are performed vaginally, laparoscopically, or a combination of the two, which is called laparoscopically assisted vaginal hysterectomy (LAVH). In all cases, the goal is the same – the removal of the uterus. Sometimes the cervix and/or ovaries are also removed.
"In many situations, they can be performed vaginally," Dr. Lingurar said. "This can include patients who have fibroid tumors."
In the other minimally invasive procedures, only two, maybe three very small incisions are made.
"One advantage to the laparoscopic method is that the surgeon can see inside the abdominal wall," Dr. Lingurar said. "Many find this helps if the ovaries are being removed too."
Minimally invasive techniques also result in quicker recovery time. The patient can be doing normal activities within a couple of weeks, whereas abdominal surgery means six to eight weeks of taking it easy.
Robotic surgery results in up to five incisions that are an inch long, instead of fewer incisions that are half that size.
A common question at Dr. Lingurar’s office is: ‘do I still need to have pap tests after a hysterectomy?’
The answer is: Yes, if the patient did not have the cervix removed, or the surgery was performed because of cancer: the pap test screens for cervical cancer.