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Minimally Invasive Surgery (MIS) Options

From the Surgery Options and Choices Articles List

Woman talking with doctor about minimally invasive surgery optionsWhen I have my hysterectomy, what choices do I have for minimally invasive surgery (MIS)?

Today, women have a wide variety of minimally invasive surgery (MIS) choices when they are facing a hysterectomy. It will depend on your specific diagnosis and the skill of your surgeon as to which choice is right for you. Below are some of the most common MIS options you can discuss with your surgeon.

Total Vaginal Hysterectomy (TVH)

The American College of Obstetrician and Gynecologist (ACOG) states, “Vaginal hysterectomy is the safest and most cost-effective method to remove the uterus for noncancerous reasons.” They further conclude that “based on the medical evidence, vaginal hysterectomy is associated with better outcomes and fewer complications than either laparoscopic or abdominal hysterectomy.” During a vaginal hysterectomy, the complete uterus with cervix is removed vaginally. Additionally, the ovaries and fallopian tubes can be removed with this method. No external incisions are needed, but an internal incision is made to separate the uterus from the vagina.

This type of surgery is most feasible for women with a benign diagnosis or carcinoma in situ of the cervix, prolapse issues, and/or a uterus that is not enlarged.

Laparoscopic Supracervical Hysterectomy (LSH)

The laparoscopic supracervical hysterectomy is an option for those who would like a minimally invasive surgery that allows them to retain their cervix. This surgery is typically performed using three or four small incisions in the abdomen. The laparoscope is used to magnify the surgical area. Other tools are inserted into the small incisions allowing the surgeon to separate the upper portion of the uterus from the cervix. To allow this portion of the uterus to be removed through a small incision, it is cut into pieces using a morcellator. As such, this surgery option may not be right for those with a cancer concern. The ovaries and fallopian tubes can be removed during an LSH.

For women with a healthy cervix, who have no prolapse or cancer concerns, this surgery may be an option.

Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

The laparoscopically assisted vaginal hysterectomy combines a vaginal hysterectomy with some of the benefits of laparoscopic surgery. During the LAVH, the surgeon can view the pelvic region by inserting a laparoscope into a small incision in the abdomen. The magnification of the laparoscope allows the surgeon to more thoroughly examine the pelvic region to look for health concerns. Using one to three other small incisions, additional instruments can be inserted to allow the surgeon to complete some of the procedure and address issues such as fibroids, endometriosis, and adhesions. With this surgery method, the complete uterus with cervix is delivered vaginally. The ovaries and fallopian tubes can also be removed with this surgery method.

This surgery type can be a good choice for women with endometriosis, fibroids, pelvic inflammatory disease (PID), adhesions, ovarian cysts, and prior surgeries.

Total Laparoscopic Hysterectomy (TLH)

Typically, the total laparoscopic hysterectomy is performed completely through three or four small incisions in the abdomen. Use of the laparoscope aids with magnification of the surgical field. During this surgery, the complete uterus with cervix is removed. In some cases, though the surgeons will complete most of the work through the small abdominal incisions, the uterus will be delivered vaginally. If the uterus is removed through a small incision, it is cut into tiny pieces using a tool called a morcellator. Unless the uterus will be delivered vaginally, this option may not be advisable for those with a cancer concern. Both the ovaries and fallopian tubes may be removed during a TLH.

Women with benign conditions, fibroids, endometriosis, and adhesions can consider this surgical choice.

Robotic Assisted Surgery (RH, RALH or dVH)

Newer hysterectomy options incorporate the use of robotics, allowing for daVinci assisted hysterectomies. Though the surgeon is fully in charge and controls all of the robot’s movements, the robotic arms and tools allow for extra precision and ambidexterity. Up to five small incisions may be made in the abdomen and one port will be used for a 3-D camera which call allow for up to 10 times magnification. During a robotic assisted hysterectomy, the uterus may be delivered vaginally or removed through one of the small incisions after it has been cut into pieces with a morcellator. If the uterus is removed through one of the incisions, the cervix can be separated and retained. The ovaries and fallopian tubes can be removed using this type of surgery.

A robotic assisted surgery can be a choice for a wide range of diagnoses including both benign and malignant conditions, as well as for both total and supracervical (or partial) hysterectomies.

Single Incision Laparoscopic Surgery (SILS) or Laparo-Endoscopic Single Site (LESS)

Using a special port, both single incision laparoscopic hysterectomy and laparo-endoscopic single site hysterectomy are performed though a single incision in a woman’s belly button. Once healed, the incision can be completely invisible. The flexible port allows for three instruments to be inserted at once, including a laparoscope to magnify the surgical area. Both complete and supracervical hysterectomies can be performed using single incision surgery. Additionally, the ovaries and fallopian tubes can be removed.

These surgeries can be options for a wide range of diagnosis including benign and malignant conditions.

To determine if one of the MIS options is right for you, talk to your surgeon. You should also seek a second opinion from a gynecological surgeon who specializes in MIS. As with any surgery, the skill and experience of the surgeon with regard to your diagnosis and the type of surgery will impact your outcome. Gynecological surgeons who specialize in MIS may perform up to 30 hysterectomies per month, allowing them to perfect many of their surgical techniques.

To learn more about the benefits of MIS, you can read the article titled Why Choose Minimally Invasive Surgery (MIS)? Additionally, the Hysterectomy Choices page includes more details about many of the different surgery choices.

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

06-05-2013 - 07:05 PM


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