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Advanced Medical Directive
CHANGE CHANGE CHANGE: Laparoscopic technology has been steadily improving allowing increasingly complex procedures. The "Minimally Invasive" surgical process involves operating inside the abdomen through very small incisions while watching a video monitor. The use of newer High frequency sound or Tissue fusion devices have replaced the old laser technology for nearly all Laparoscopic surgeries. Usually three tiny 5 mm incisions are made in the patient's abdomen to accomplish a Laparoscopic hysterectomy. The procedure involves removal of the uterus and tubes. The ovaries are usually left in place but may be removed for ovarian cancer risk, endometriosis or other specific reasons.
BENEFITS: most women experience less pain, shorter hospital stay and a much shorter recovery time (just ten to fourteen days). Other benefits include less risk of surgical complications, scar tissue and infection. Furthermore there is better long-term support of the top of the vagina which may protect sexual health and allow earlier return to normal sexual activity. For obese patients, this approach may actually be better than the other options. The day after surgery most patients are up and dressed, eating their breakfast and preparing for dismissal. One of the common problems following total abdominal hysterectomy is vagina falling due to poor supports. Laparoscopic Hysterectomy preserves the pelvic floor supports.
CONCLUSION: Simply put, this Minimally Invasive procedure allows patients to return to their normal lives sooner. After this surgery, patients are generally sore and have a little difficulty getting up and down, but don't feel marked pain. If they chose, women can usually return to work in two weeks (four to five weeks sooner than with usual abdominal hysterectomy) and this has a tremendous economic and personal impact.
Hysterectomy is performed on more than 600,000 women each year in the United States usually through a six inch abdominal incision that requires two to four days in the hospital and a four to six week recovery time. This is one of the most commonly performed surgical procedures. Reasons for hysterectomy include abnormal menstrual bleeding, smooth muscle tumors of the uterus (also called myomas or fibroids) and a variety of pelvic pain disorders. Vaginal hysterectomy is one traditional alternative to abdominal hysterectomy. The vaginal approach is performed by removing the uterus through an incision in the vagina. It does require a shorter two-day hospital stay and four-week recovery period.
TOTAL LAPAROSCOPIC HYSTERECTOMY VERSUS ABLATION:
Total Laparoscopic Hysterectomy (TLH) is one procedure, one anesthesia and is Definitive.
TLH reduces cancer risk for the uterus and cervix (and ovaries if they are removed).
TLH eliminates the need for future Pap smear screening.
TLH eliminates the need for future diagnostic evaluation of abnormal vaginal bleeding.
TLH eliminates the risk of pregnancy therefore no Vasectomy or Tubal Ligation is required.
TLH allows the safer "estrogen only" hormone replacement therapy in the menopause.
TLH is associated with high patient satisfaction and no negative impact on sex drive, urine control or prolapse.
ABLATION IS LESS INVASIVE: (can go home 90 minutes after the procedure is done) BUT ...
Ablation still often requires general anesthesia.
Ablation requires 2nd surgery (tubal ligation or vasectomy) for birth control.
Ablation has an overall failure rate approaching 30%.
Ablation may increase risk of delayed diagnosis of malignancy.
Ablation creates need for continued Pap smears.
Ablation requires diagnostic evaluation of future abnormal bleeding or possible pregnancies.
Ablation may create new pelvic pain in 5% of patients.
Ablation requires less safe "estrogen and progesterone" for hormone replacement therapy
COCHRANE DATABASE* RESULTS: randomized control trials of 706 women...
24% of ablation patients subsequently needed a hysterectomy
38% of ablation patients subsequently needed additional surgery.
Amenorrhea 23%, failure rates 16%, post procedure pain 5%.
ABLATION-FAILURES MOST LIKELY: if the woman is less than 45 years of age, has had 5 or more children, or had a previous tubal ligation or severe menstrual cramps.
HYSTERECTOMY IS NOW LESS INVASIVE: there is a shift back in the direction of Hysterectomy as being more likely to cure conditions associated with bleeding and pain. Minimally Invasive Hysterectomy also markedly reduces the need for future workups and it makes hormone replacement therapy more safe.
HYSTERECTOMY: should I keep my ovaries?