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Format: 04/18/2014
Format: 04/18/2014


Pittsburgh Post-Gazette: Minimally invasive hysterectomies often a good choice for women

Friday, July 10th, 2009

By Pohla Smith

Pittsburgh Post-Gazette

Allegheny General Hospital personnel rolled Tinisha Nelson into a surgical suite for her robot-assisted laparoscopic hysterectomy about 2 p.m. on June 11. By 4 p.m., the procedure surgeon James Garver did with the aid of the big, two-piece robotic device was over.

The North Side mother of three went home the following evening. She was sore and still unable to feel when she needed to use the bathroom, and she was forbidden to take stairs for a few days, but she was home nevertheless.

If Mrs. Nelson, 28, had had the hysterectomy, or removal of her uterus, by conventional means, she could have been hospitalized for as long as four days. That's because the most common type of hysterectomy is via an abdominal incision of 5 to 7 inches that also is known as a laparotomy. The da Vinci Surgical System-assisted laparoscopic surgery requires just four, dime-sized incisions that readily heal up like dimples.

Time of total recovery from an abdominal hysterectomy probably also would have been longer than that facing Mrs. Nelson.

According to medlineplus.gov, an online encyclopedia run by the U.S. National Library of Medicine and the National Institutes of Health, recovery from the big-incision surgery averages four to six weeks after leaving the hospital.

Dr. Garver said some of his patients who have had da Vinci-assisted laparoscopic hysterectomies feel well enough after two weeks' rest to return to desk jobs. Intuitive Surgical Inc., the Sunnyvale, Calif.-based maker of the da Vinci, says patients sometimes even can resume normal activity in less than a week.

And the robot-assisted laparoscopy is just one of several methods of hysterectomy that fall into the category officially labeled "minimally invasive surgery," or operations done for the same purpose but with smaller incisions than open surgery.

The most common minimally invasive procedure, sometimes counted as a category by itself, is a vaginal hysterectomy, in which the uterus is removed through an incision in the vagina.

Then there are the laparoscopic-assisted vaginal hysterectomy; surgery by use of laparoscopes only; and the da Vinci. In the da Vinci, the surgeon sits at a console and, while using both hand and foot controls and viewing a highly magnified three-dimensional image of the surgical area, operates two or three instrument arms and a camera/light called an endoscope.

The newest minimally invasive procedure is the single incision laparoscopy, better known as bellybutton surgery because the 11/2-inch incision is done through the navel.

The many options are all designed to reduce recovery time and, in most cases, pain, while providing less noticeable scarring.

Yet only 35 percent of the approximately 600,000 hysterectomies the Centers for Disease Control and Prevention says are performed each year were done laparoscopically or vaginally in 2006, according to statistics gathered by the American College of Obstetrics and Gynecology. Twelve percent of those 600,000 were laparoscopically assisted vaginal surgeries and 4 percent were laparoscopic alone.


To read more, visit the Pittsburgh Post-Gazette web site.

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