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Quicker recovery from keyhole hysterectomy

A hysterectomy is the surgical removal of the uterus that some 30,000 Australian women require every year for abnormal bleeding, pain or cancer of the uterus.

A new study led by my former trainee and now Professor of Obstetrics and Gynaecology in Dublin, confirms that every hysterectomy should be performed through minimally invasive surgical techniques. Women who had keyhole surgery (laparoscopic) recorded much better quality-of-life scores when asked up to 6 months after surgery.

That means that all women who need a hysterectomy should be offered keyhole surgery, regardless if the hysterectomy is performed to treat uterine cancer or the procedure is necessary because of a non-cancerous reason.

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There are very few exceptions when keyhole surgery should not be performed.

  • If a hysterectomy is required for cervical cancer an open procedure through an abdominal procedure is safer. In one of our studies we have shown that the risk of tumour recurrence is lower for patients with cervical cancer if they have an abdominal incision. These operations are performed by gynaecological oncologists.
  • If a hysterectomy is part of a procedure to remove a pelvic mass that is suspicious for ovarian cancer, I would suggest that a gynaecological oncologist is in a better position to weigh the pros and cons and then judge if a laparoscopic procedure is still preferred.

In all other cases, almost all patients will benefit from a keyhole surgical approach. Recovery from surgery is quicker and the risk of complications after surgery is lower. Return to normal daily activities is also quicker.

In my practice 93.3% of all hysterectomies performed for non-cancerous reasons are done through laparoscopic surgery. Unfortunately, one in 30 patients where we start with a laparoscopic (keyhole) procedure, is not suitable for that and a decision has to be made during the operation that an abdominal incision is required to complete the procedure safely. The most common reasons for those “conversions” are distorted anatomy and dense adhesions (abdominal organs stuck together when they should not). In that case the risk of unrecognised injuries to other organs (bowel, bladder, ureters) would be unacceptably high and the consequences would be highly undesirable for the patient. I am aware that those women may be disappointed and may suffer from prolonged surgical recovery. However, I can only offer my assurances that making a decision to open an abdomen for a hysterectomy is never taken lightly.

Women for who a swift recovery after surgery is important (for example for work reasons) should ask their gynaecologist these questions: How many procedures do you perform a year; how many do you perform through keyhole surgery; and how many of those require conversion to open surgery.

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