Ask the Doctor at Saint John’s: Minimally Invasive Options for Hysterectomy

Q. We keep hearing about minimally invasive surgery for back or hip issues, are there any minimally invasive options for gynecological conditions?

By Ronald Leuchter, M.D., gynecological oncologist at the John Wayne Cancer Institute at Saint John’s Health Center

Indeed there are. In fact gynecologists were at the forefront of using laparoscopic instruments – long, thin fiber optic tubes -- to look at tissues and organs inside the abdomen. During the ‘60s and ‘70s, gynecologists had embraced and incorporated laparoscopy into their practice, while general surgeons continued to practice traditional open procedures.

It was not until the late 1980s, after the development of a video computer chip that allowed images to be magnified and projected onto television screens, that laparoscopic surgery techniques fully integrated the field of general surgery. These minimally invasive procedures have changed the discipline more drastically and more rapidly than any other surgical milestone.

Today, we can use minimally invasive procedures for many gynecological surgeries, including hysterectomy, the second most common surgery among women in the United States. We can do a total hysterectomy (removal of the uterus and cervix), a partial hysterectomy (removal of part of the uterus but leaves the cervix) and even a radical hysterectomy (removal of the entire uterus, cervix, top section of the vagina and pelvic lymph nodes.)

There are several minimally invasive options for hysterectomy. We can go through the vagina, or we can make small incisions in the abdomen. Both offer the benefits of faster recovery and less scarring than a traditional open procedure. We can also remove the ovaries with minimally invasive surgery.

But we don’t always remove the ovaries when doing a hysterectomy. When I was in training, anyone over 40 was old enough to have their ovaries removed. But we don’t think that way now. The ovaries continue to work in a declining fashion for a variable time after the cessation of menstrual periods that is menopause, and the average age of menopause is 50. Today, we only add removal of the ovaries to a hysterectomy if a woman is at menopause, unless, of course, there’s a medical indication for removing the ovaries, such as cancer.

In my practice, I treat cancers associated with the female reproductive system – ovarian, cervical and uterine. It’s not always appropriate to recommend a laparoscopic surgery, depending on the size of a tumor or the stage, but I always think about it first. Minimally invasive procedures result in less hospital time, less scarring and pain and a faster recovery, with the same end result.

Ronald Leuchter, M.D., is a gynecological oncologist at the John Wayne Cancer Institute at Saint John’s Health Center. For more information about Dr. Leuchter and other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

Want to learn about a variety of health and lifestyle issues? Watch “Coffee Break,” a weekly live television show broadcast Wednesdays from 2 to 3 p.m. on Santa Monica City TV Channel 16 and LA City TV Channel 36.