A kinder, gentler hysterectomy?

Each year about 600,000 women in the U.S. get a hysterectomy -- and despite medical advances in recent years, some will face a longer, more painful recovery than they might have needed. That's because newer, less invasive surgical procedures are still not being fully implemented.

Hysterectomy -- surgery to remove all or part of the uterus and sometimes other parts of the reproductive system such as the ovaries and fallopian tubes as well -- is the second most common surgical procedure for American women, after C-section, according to the U.S. Department of Health and Human Services.

Experts say that before going through with the operation, there are some important questions women should ask their doctors, and several surgical options they should know about.

Dr. Lori Warren, a gynecologic surgeon and a partner with Women First of Louisville, says the number one question women should ask is whether the surgery is medically necessary: "Do they really need a hysterectomy, or are there alternative treatments?"

Speaking with CBS News chief medical correspondent Dr. Jon LaPook, Warren explained that women may undergo the procedure for a number of reasons. It is sometimes recommended for painful uterine fibroids, abnormal bleeding, chronic pelvic pain, endometriosis, and uterine prolapse, a condition in which the pelvic floor fails to support the uterus after childbirth.

In many cases, prescription medications or a less invasive procedure may help alleviate symptoms and could be worth trying first. For most patients, hysterectomy should be a last resort if other treatments fail to work.

If a hysterectomy is needed, there is another important choice to be made about which type of surgery is best for an individual woman's case.

"By and large," Warren said, "The vast majority of these surgeries can be done with very small incisions, which is really revolutionary and it's changed the way we practice medicine."

In recent years, less invasive methods of hysterectomy have become more widely available to patients. They include laparoscopic and robotic-assisted surgery, which entail much smaller incisions. Some doctors even conduct the procedure trans-vaginally.

But even though these advanced techniques are practiced by many in the medical specialty, abdominal hysterectomy, the oldest procedure, is still widely used. A 2013 study published in JAMA looked at the rates of hysterectomy and the type of procedures 264,758 women underwent between 2007 and 2010.

Of that number, about 47 percent had an abdominal hysterectomy, 21 percent had a vaginal hysterectomy, 29 percent had a laparoscopic procedure and 4 percent opted for robotically-assisted surgery.

The researchers found that rates of laparoscopic surgery increased from about 24 percent in 2007 to 31 percent in 2010. However, in that time period, abdominal hysterectomy still accounted for a large percentage of cases: 54 percent in 2007, decreasing to 40 percent in 2010.

Warren said doctors may stick to performing abdominal surgery because they haven't been trained in the laparoscopic techniques. Additionally, laparoscopic and other minimally-invasive procedures are more difficult and more costly for doctors to perform.

Warren, who is also the founder of passthepearls.org -- a non-profit organization that educates about women's health and gynecologic surgery options -- said women who undergo traditional, abdominal hysterectomy tend to experience much more pain and discomfort, as well as a longer recovery time.

Typically it takes women 4 to 6 weeks to recover from abdominal hysterectomy, whereas women who have the surgery laparoscopically or vaginally, can usually resume normal activity much more quickly. "And it's a big issue for a woman to have six weeks off as opposed to two weeks off," notes Warren.

A review of 34 studies on hysterectomy, published by the Cochrane Database System Review in 2009, compared the three most common approaches to hysterectomy: abdominal, vaginal and laparoscopic. The review, which accounted for 4,495 women, found the recovery time and rates of infection were better for vaginal hysterectomy than for abdominal surgery. Women who underwent laparoscopic surgery were able to resume normal activities much sooner than women who underwent abdominal surgery. Laparoscopic patients were also less likely to experience blood loss during surgery and had shorter post-operative hospital stays than patients who had abdominal surgery.

Warren said any woman who is considering hysterectomy should talk with more than one doctor to find the type of surgery that will be most beneficial in the short- and long-term.

"If you're told that you may need to have an open procedure, whether it's for a hysterectomy or to remove a benign tumor or any gynecologic procedure, try to seek out those doctors in your community that have expertise with minimally-invasive surgery, because they're there and it may really make a difference in the quality of surgery, but also the recovery and also the pain and suffering to that individual."

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