Questions to Ask If Your OBGYN Recommends an Open Hysterectomy
Since 2017, the American College of Obstetricians and Gynecologists has recommended that hysterectomies be performed using a laparoscopic method instead of an open, or abdominal, approach whenever feasible.1 Minimally invasive hysterectomies, the organization affirms, have been proven to offer better outcomes for patients. So why are roughly half of hysterectomies in the United States still performed via the open route?
While there are some circumstances when an open, or abdominal, hysterectomy may be medically necessary, make sure to ask your doctor the following questions so you can make an informed decision regarding the right surgical treatment for you.
How many hysterectomies do you perform each year, and are they all open?
Many OBGYNs spend the majority of their time on obstetrics (pregnancy and delivery) and general gynecological health care rather than surgical procedures like hysterectomy. Hysterectomies are often performed by doctors who are low-volume surgeons —those deemed in one study to perform between six and 10 of these procedures a year — and their hysterectomies are frequently performed with the open method rather than a minimally invasive approach. When researchers analyzed the complication rates in 5,660 hysterectomies performed in the state of Maryland over two years, they concluded that having a hysterectomy performed either by a high-volume surgeon or with a minimally invasive technique can reduce the chances of “preventable harm.”2
CIGC’s experts are highly experienced, board-certified laparoscopic surgeons who are fellowship trained in minimally invasive GYN surgery. As full-time surgeons who have performed more than 25,000 GYN procedures, they are dedicated to surgical care with minimal scarring, the lowest complication rates and fastest recovery.
Why do you recommend the open method for performing my hysterectomy?
If your OBGYN has said an open approach is best for any of the following reasons, seek a second opinion:
- Your uterus or fibroids are too large.
- You have extreme endometriosis and/or pelvic adhesions (scar tissue).
- You are too heavy (have a high body mass index, or BMI).
- You had a cesarean section.
More than 95% of women can have a minimally invasive hysterectomy with the DualPortGYN method from CIGC. This approach allows our specialists to treat most hysterectomy patients with any of the above conditions using just two ¼-inch incisions, not the 6-inch abdominal incision required with open hysterectomy.
The average uterus in an adult patient weighs about ¼ pound. DualPortGYN has been used to remove uteri up to 11 pounds. And regardless of uterine size, the presence of endometriosis, scar tissue, the patient’s BMI or history of cesarean births, DualPortGYN hysterectomies have significantly lower complication rates and enable dramatically faster recoveries compared to open hysterectomy.
DualPortGYN’s advantages are the result of two advanced techniques — retroperitoneal dissection and uterine artery ligation — that reduce the risk of injury and control blood loss. The retroperitoneal approach is an advanced skill that requires a high degree of specialized training, and CIGC’s experts are among the few GYN surgeons nationally and internationally who routinely use it.
What complication rates do you experience with open hysterectomy?
Compared to all minimally invasive methods of performing hysterectomy, the open route has the highest rates of intraoperative and post-operative complications, including infection. DualPortGYN’s advanced retroperitoneal and uterine artery ligation techniques allow CIGC hysterectomy specialists to achieve low complication rates both during and after surgery.3,4
How long will I be in the hospital?
Patients who have an open hysterectomy may spend up to three days in the hospital due to the long incision required with this approach and the impact on the abdominal muscles. Both of these factors can cause considerable pain.
At CIGC, your procedure will take place in a modern, freestanding ambulatory surgery center (ASC), which means you’ll return home the same day. Because your hysterectomy is not performed in a hospital, where patients with COVID-19 are treated, and because ASCs are smaller and easier to safeguard against infection, ASCs are ideally suited to protecting patients’ health and safety.
How long will my recovery take?
In addition to the higher rate of complications with open hysterectomy, this approach can mean up to eight weeks of recovery.
Because a DualPortGYN hysterectomy requires just two small incisions, most patients are back to their routine in about a week to 10 days. Many patients report being able to go for walks within several days of surgery.
Regardless of the surgical approach, it takes about eight weeks for hysterectomy patients to heal internally. During this time and until their doctor says it’s safe, they will need to refrain from intercourse and putting anything into the vagina, including tampons and douches.
How big will my scars be?
Accessing the uterus with an open hysterectomy requires the surgeon to make one incision in the abdomen that’s about 6 inches long. This incision may be horizontal (typically along the bikini line) or vertical, with the latter running from just below the navel to slightly above the bikini line.
Most patients who have a DualPortGYN hysterectomy receive just two ¼-inch incisions that within a few months are barely visible. They are placed in the belly button and at the bikini line. Rarely, an additional one or two ¼-inch incisions may be needed for a patient with an exceptionally large uterus or other condition that can’t be accommodated with two incisions.
Considering a hysterectomy and not sure about an open procedure versus a minimally invasive option? Consult with one of the GYN surgical specialists at CIGC. They are experts in the retroperitoneal dissection and uterine artery ligation techniques that provide unmatched outcomes compared to open hysterectomy.
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The co-founders of The Center for Innovative GYN Care, minimally invasive GYN surgical specialists Paul MacKoul, MD, and 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 more than 25,000 complex GYN procedures and are constantly finding better ways to improve outcomes for patients.
¹Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. Obstet Gynecol. 2017;129(6):e155-e159. doi:10.1097/AOG.0000000000002112
²Mehta A, Xu T, Hutfless S, et al. Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications. Am J Obstet Gynecol. 2017;216(5):497.e1-497.e10. Doi:10.1016/j.ajog.2016.12.020
3Danilyants N, MacKoul P, Baxi R, van der Does LQ, Haworth LR. Value-based assessment of hysterectomy approaches. J Obstet Gynaecol Res. 2019;45(2):389-398. doi:10.1111/jog.13853.
4Open complication rates calculated from literature review of comparable studies