The following article is written by Manisha Shah-Bugaj, director of marketing in the surgical energy division of Gyrus ACMI, an Olympus company.
Approximately 600,000 hysterectomies (surgical removal of the uterus) are performed annually in the United States, with an estimated 20 million women undergoing the procedure to date.[1] In fact, one-third of U.S. women have had a hysterectomy by age 60.[2] Market analysts from The Advisory Board (ABCO) predicted a growing trend in 2010 and subsequent years in surgeons performing a minimally invasive surgical procedure called laparoscopic hysterectomy.[3] The trend toward minimally invasive hysterectomy is likely driven by the increase in both supply and demand for the procedure. There is an increase in fellowship-trained gynecologic surgeons specializing in laparoscopic surgery (supply), as well as women's increased awareness of their surgical options (demand).
Historically, hysterectomies have been performed through a large incision in the abdominal wall. Like many other invasive surgeries, abdominal hysterectomies can involve fairly extensive recovery periods of up to six weeks for patients. The advent of new technology, however, has made less invasive techniques possible, including vaginal hysterectomies, performed through an incision at the top of the vagina, and laparoscopic hysterectomies, involving a few small incisions in the abdomen through which surgical instruments and a laparoscope are inserted to perform the surgery.[4]
As the name suggests, the key to laparoscopic surgery is the laparoscope, a medical instrument that can be used to explore areas inside the human body such as the abdomen, gallbladder, colon, kidney, stomach, intestines, pancreas, bladder and spleen, as well as all of the female organs and the prostate in men. The laparoscope itself consists of a miniature video camera attached to the end of a slender telescopic instrument. Its small size allows it to be inserted through a tiny incision in the abdomen, usually at or near the navel, giving the clinician a clear, real-time view inside the abdominal cavity. The images captured by the video camera are streamed live onto a video monitor. In the case of a laparoscopic hysterectomy, the surgeon has a clear and close-up view of the female reproductive organs, and the monitor serves as the viewing field for the surgical procedure. The uterus is detached laparoscopically using surgical instruments inserted through other small incisions in the abdomen. The detached organ is then removed through a small incision at the top of the vagina or through the navel area.[4]
The ABCO predicted that by the end of 2010, 44 percent of all hysterectomies undertaken in the United States will be performed laparoscopically, and by 2017, this figure is expected to jump to 55 percent.[3] This is good news for women from both a clinical and cosmetic perspective. Since successful laparoscopic hysterectomies require only a few small incisions (usually 0.5–1.5 cm long),[5] they can be less disfiguring than abdominal hysterectomies that require larger incisions and can leave behind unsightly scars.
Open abdominal surgery still method of choice for hysterectomy
Despite the prevalence of laparoscopic procedures, open abdominal surgery still remains the most common approach to hysterectomy.[6] Laparoscopic surgery is much more widely used in procedures such as gallbladder removal and other abdominal surgeries. In fact, according to the National Institute of Health, almost all gallbladder procedures are performed with laparoscopy. [7] Likewise, laparoscopy is widely used in gastric banding procedures for obesity (100 percent of the time), tubal ligation for contraceptive purposes (70 percent of the time) and appendectomy (60 percent of the time).[3] In contrast, some sources indicate that laparoscopic hysterectomy currently accounts for only about 15 percent of all hysterectomies performed in the United States.[7] Other sources cite figures as high as 40 percent, but all data indicates the usage rate of laparoscopy for hysterectomies is far lower than its usage rates for other common abdominal procedures.[8]
A number of opinions have been offered for the slow adoption of laparoscopic hysterectomy. Some observers point to the greater familiarity that OB/GYNs have had with open abdominal surgery based on years of performing abdominal C-sections for women in childbirth.[9] Others cite the limited training that OB/GYNs receive on new techniques during residency.[10] The physician-patient relationship also plays a role in acceptance rates of laparoscopic hysterectomy. According to Franklin Loffer, MD, of the American Association of Gynecologic Laparoscopists, "Women have a relationship with their OB/GYNs. They trust them and tend to stay loyal to them. That makes OB/GYNs less motivated to change what they are accustomed to doing."[9]
Irrespective of the reasons, the benefits of minimally invasive surgery like laparoscopy are well-established and have set the stage for future innovation — good news for women as next generation operating techniques could further reduce recovery times and complication rates while enhancing clinical outcomes and hold even fewer scars.
For more information about laparoscopic hysterectomy and treatment options visit www.herhealth.org, published by Gyrus ACMI.
About the author: Manisha Shah-Bugaj is the director of marketing in the surgical energy division of Gyrus ACMI, one of the world's leading suppliers of medical visualization and energy systems and now an Olympus company. She oversees strategy and business development in the gynecology and urology market segments for the surgical energy business and works closely with surgeons to develop new products to help advance minimally invasive surgery.
References
[1] Department of Health and Human Services. Centers for Disease Control and Prevention. Women's Reproductive Health: Hysterectomy. http://www.cdc.gov/reproductivehealth/WomensRH/Hysterectomy.htm. Last reviewed 5/7/09. Accessed 1/17/10.
[2] Medline Plus, a service of the National Library of Medicine and the National Institute of Health. Hysterectomy. http://www.nlm.nih.gov/medlineplus/hysterectomy.html. Last updated 1/4/10. Accessed 1/17/10.
[3] Bentley F, Hartman J. Future of Surgery: Strategic Forecast and Investment Blueprint. Health Care Advisory Board. 2009:26.
[4] The American Association of Gynecologic Laparoscopists. Patient Education Topics: Hysterectomy. www.aagl.org/topics (TREATMENTS>Hysterectomy). Reviewed 3/08. Accessed 1/17/10.
[5] American Medical Association. Complete Medical Encyclopedia. Random House Reference. 2003:768-770.
[6] Einarsson J, Suzuki Y. Total Laparoscopic Hysterectomy: 10 Steps Toward a Successful Procedure. Clinical Obstetrics and Gynecology. 2009;Winter:2(1):57-64.
[7] National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases. National Institute of Health. http://www.digestive.niddk.nih.gov/ddiseases/pubs/gallstones/#6. NIH Publication No. 07-2897. July, 2007. Accessed 1/17/10.
[8] Sokol A, Green I. Laparoscopic Hysterectomy. Clinical Obstetrics and Gynecology. 2009;52:304-312.
[9] Rosen P. More.com. The Endangered Uterus. http://www.more.com/4488/2382-the-endangered-uterus. Originally published in MORE magazine. December 2008/January 2009. Accessed 1/17/10.
[10] Reich H. Total Laparoscopic Hysterectomy: Indications, Techniques, and Outcomes. Current Opinions in Obstetrics and Gynecology. 2007;19:337-344.