There are many options for hysterectomy procedures. Recovery for each procedure depends on the skill of the specialist, placement of the incisions and technique used for removal and control of blood loss. These factors all play into patient safety, surgical outcomes and both the length and quality of a patient’s recovery.

Laparoscopic hysterectomy recovery has been proven to have overall better outcomes for patients, but choosing an experienced minimally invasive GYN surgeon has a direct impact on surgical success and recovery.

LAPAROSCOPIC HYSTERECTOMY RECOVERY: WHEN TO GET A SECOND OPINION: QUESTIONS TO ASK & THE IMPORTANCE OF THE RESPONSES

Many women are hesitant to question their physicians, especially when there is a long-term relationship. However, surgery, in particular laparoscopic surgery, may not be the forte of an experienced OBGYN. Obstetrics and gynecologic surgery are two separate skills. Some physicians may choose to focus on obstetrics, which can limit their surgical volume or skill development.

It’s necessary to ask the following questions and get specific answers to ensure that the outcomes of the procedure are ideal.

HAVE YOU HAD FELLOWSHIP TRAINING IN MINIMALLY INVASIVE GYN SURGERY?

• Fellowship trained GYN surgeons have more training, skill, and surgical volume than general practitioners (these include OBGYNs).
• Fellowship training takes two to three years to complete through an approved program after completion of residency.
• Fellowship trained surgeons devote their career entirely to minimally invasive surgery, and do not perform obstetrics. That means that there is more surgical volume and surgeons are more likely to have encountered complex conditions. When it comes to GYN surgery, volume matters.

HOW DO YOU PERFORM A HYSTERECTOMY?

• If an open or robotic procedure is recommended, it is important to get a second or even a third opinion.
• Many non-specialists still perform open (abdominal) procedures which have large incisions. Open procedures are more painful and have a longer recovery that can have a negative effect on a patient’s emotional well-being, their employment or income if long-term disability is not available.
• Some surgeons are now performing hysterectomy procedures using a robot. The number of incisions, limited view, and the amount of time spent in surgery can all create complications that may necessitate a conversion to open surgery.
  • A subsequent question for the surgeon would be “If you are using a standard laparoscopic or a robot to perform the surgery, how often have you had to convert to open surgery?” If the answer is more than 1 percent, seek a second opinion.

HOW LONG IS THE PROCEDURE & WILL THERE BE A HOSPITAL STAY?

• The longer the procedure takes, the higher the risk to the patient. Complications can result from blood loss and being under general anesthesia for longer periods of time. While the risk of blood loss is the most immediate danger, it is important that patients also are aware of the risks of anesthesia, which can include blood clots in the legs that can make their way to the lungs and become life-threatening, memory or disorientation problems after surgery (this increases with age), and depending on a patient’s overall health, pneumonia, stroke or heart attack are possible.
• Standard and robotic procedures often require an overnight stay in the hospital. Open surgeries can require 3-5 days in the hospital.
  • Advanced procedures can be performed in an outpatient setting, which means that patients return home the same day and reduce the risks of hospital-related infections.

OPEN HYSTERECTOMY IS RARELY NECESSARY WITH A SKILLED SPECIALIST

If hysterectomy is indicated, it should be performed by a minimally invasive specialist who can also identify and resect complex GYN conditions like endometriosis or pelvic adhesions (scarring) completely, and repair the areas where endometriotic lesions or scarring are removed. In many cases, these conditions can damage the bowel or the bladder so it is essential that the surgeon has the skills and experience to repair these organs during the same procedure for the safety of the patient. Otherwise, patients may require additional emergency surgery if the bowel or bladder is injured.

In robotic or even standard laparoscopic procedures, encountering these complications often means that surgeons may convert to an open procedure.

The skills required to perform complex laparoscopic GYN procedures are not practiced by generalists, including OBGYNs. According to ACOG, the average number of hysterectomy procedures performed annually by an OBGYN is 27. Many of these procedures are performed as open surgeries, especially if the patient is suffering from an enlarged uterus or large fibroids.

FELLOWSHIP-TRAINED GYN SPECIALISTS HAVE THE EXPERIENCE AND SKILLS FOR BETTER PATIENT OUTCOMES

In 2016, the CIGC specialists performed over 2,000 laparoscopic GYN procedures. To understand the importance of experience with complex conditions, CIGC specialists have:

• removed more than 100 fibroids during one procedure,
• removed extremely large fibroids, including one that was 20 lbs;
• performed extensive endometriosis excision with resection of pelvic adhesions that essentially freeze the pelvis;
• welcomed women to our practice from around the world, including Jakarta, Indonesia.

CIGC performs high volume laparoscopic surgery at a high level of expertise for some of the most complex GYN conditions that cannot be treated by other surgeons unless the surgery is performed as an open procedure.

ADVANCED SURGICAL TECHNIQUES IMPROVE HYSTERECTOMY PATIENT OUTCOMES

The average laparoscopic hysterectomy procedure at CIGC is less than an hour. Some procedures may take longer. The CIGC exclusive techniques for a DualPortGYN hysterectomy. These techniques ensure efficiency in every surgical procedure, controlling for blood loss and mapping the pelvic cavity so that visibility is high.

Once these techniques are complete, the time spent on the surgery is fast. The less time under anesthesia is better for the patient. It is also important to perform a thorough procedure. Using these advanced techniques, CIGC specialists can achieve both. All procedures performed by CIGC specialists are outpatient. That means patients go home from surgery the same day, and recover in the comfort of their own homes. There is no required hospital stay.

A DualPortGYN hysterectomy is performed using just two tiny incisions. Their placement is important. Both incisions avoid the abdominal muscle, so the pain from surgery is significantly less than if it were performed as a standard laparoscopic or robotic procedure, where multiple incisions are placed through the abdominal muscles.

Most CIGC hysterectomy patients are back to their normal activities within one week or less.

BOOK A CONSULTATION

CIGC is dedicated to providing information and materials for women to help navigate the complicated healthcare system. The CIGC founders, minimally invasive GYN surgical specialists Dr. Paul MacKoul, MD and Dr. Natalya Danilyants, MD, developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind.

Their personalized approach to care helps patients understand their condition and the recommended treatment so that they can have confidence from the very start. Our surgeons have performed over 20,000 GYN procedures and are constantly finding better ways to improve outcomes for patients.

Book a consultation today with Paul MacKoul MD or Natalya Danilyants MD.

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