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A Fresh Look at Hysterectomy

For quicker hysterectomy recovery, many women are choosing laparoscopy. Just make sure your surgeon is skilled.

The Pros and Cons of Laparoscopic Hysterectomy continued...

But cost may be a factor to consider: A laparoscopic procedure generally takes longer and is more expensive than the standard abdominal hysterectomy. "The cost is double the cost of an abdominal surgery," Tse says. "If you are in a PPO where you have to pay 20%, that may be an issue."

The skill level among surgeons is another big issue. "You have to find someone who is very experienced, or they can do a lot of damage," Tse says.

Most gynecologists can perform the laparoscopic-assisted vaginal hysterectomy (LAVH), which debuted in the late 1990s. But total laparoscopic hysterectomy is much newer -- with the first cases performed in 2005, Tse explains.

"Among garden-variety gynecologists, not many are doing it. Or they're performing the surgery without really knowing how to do it," she says.

If the surgeon is not skilled, there is more risk to the patient, says Ted Lee, MD, director of the laparoscopy fellowship program at University of Pittsburgh School of Medicine. "Choose your surgeon carefully. Find someone you trust -- and who is honest about whether you are really a good candidate for it. You don't want a surgeon who is just doing the procedure to practice it."

Finding the Right Surgeon for Your Hysterectomy

To find a skilled surgeon, Tse advises asking:

  • How many total laparoscopic procedures have you performed? An experienced surgeon will have performed at least 25 to 50, she says. 
  • Also ask how many times the surgeon has started a laparoscopic procedure, then decided to switch to an abdominal incision, called the "conversion rate. " A good surgeon's conversion rate should be less than 5%, Lee explains.

Bottom line: Your surgeon needs to offer all the options. "If they are well-versed in all procedures, they can offer the patient appropriate care," Lee tells WebMD. "Otherwise, it's the old saying: If you only have a hammer, everybody's a nail. A surgeon who has more tools can best serve the patient."

Common Reasons for Hysterectomy

The common reasons for hysterectomy are:

  • uterine fibroids
  • severe vaginal bleeding
  • uterine prolapse
  • endometriosis
  • chronic pelvic pain

Hysterectomy is also used to treat uterine and cervical cancer.

Hysterectomy: Emotions and Alternatives

Depending on a woman's age, the choice to have a hysterectomy can be an emotionally tough decision. It means that she can no longer have children. That's the crux of hysterectomy -- the uterus (or part of it) is removed.

"Hysterectomy is a very personal thing for women," explains Tse. "Some are so thankful to be done with this troublesome organ. For others, there is grief over the loss of womanliness, their ability to have children."

Today, women know they have many options, adds Katherine Hartmann, MD, PhD, vice-chairwoman of obstetrics and gynecology at Vanderbilt University School of Medicine in Nashville.

  • Medications and the IUD Marena can control heavy bleeding in some women. 
  • A surgery called myomectomy can remove troublesome fibroids while leaving the uterus intact -- a good option for women who want to have children. 
  • Uterine artery embolization -- destroying the lining of the uterus – can also reduce bleeding. So can endometrial ablation. But most women cannot get pregnant after endometrial ablation, and it’s not yet clear whether uterine artery embolization reduces chances of pregnancy.

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