Are Women Getting The Wrong Operation?

Hundreds Of Thousands Of Women Get Invasive Surgical Hysterectomy When There's An Alternative

(CBS)  In collaboration with Business Week, CBS News has been investigating breakthroughs in the way patients undergo surgery. One involves an operation that one-third of women undergo by the time they're 60. It can lead to weeks of painful recovery. But it turns out, that kind of discomfort and recuperation time can be significantly decreased, CBS News medical correspondent Dr. Jon LaPook reports.

---

Dr. Lori Warren is a surgeon who has a startling diagnosis for women. She thinks hundreds of thousands of them are getting the wrong operation every year.

"I'm outraged that doctors are still, in my mind, doing these archaic surgeries on people; we're opening them up unnecessarily," Warren said.

The surgery she's upset about may be archaic - but it's very common.

Hysterectomy is the surgical removal of the uterus. About 600,000 of them are done every year in this country. Most are recommended because of pain and bleeding from fibroids.

"If patients really know that they have options when it comes to hysterectomy, we will start seeing some of the changes that I feel need to happen," Warren said.

What's happening now is that the vast majority, about 70 percent, are done the old-fashioned way, with a large surgical incision, lots of pain, and a six-to-eight-week recovery.

"I just think we need to open less people up," Warren said.

Warren is one of relatively few surgeons who perform hysterectomy with a minimally invasive, laparoscopic technique.

Like all laparoscopic procedures, a camera is inserted through a tiny incision to see into the abdomen; two other small incisions are made so that tools can be inserted to perform the surgery.

It's all over in about an hour, and patients are usually home within a day and back to normal within a week or two.

"Does it still amaze you after all these years," LaPook asked.

"Oh yeah, I'm amazed by what we can do and what's most amazing to me is how well the patient does," she said.

---

Read more from our partner in investigating this topic, Business Week, by clicking here.

---

Becky Ruppert had a hysterectomy just before LaPook talked with her - literally. And right away, she wanted to go home.

LaPook said: "So about five hours ago, you had your uterus out, and how do feel now?"

"I feel great," Ruppert said. "I have no pain. Literally, no pain."

What frustrates Warren is that only about 15 percent of hysterectomies are done this way.

"You would think in today's age and the way that we've improved in so many areas of medicine, women would begin questioning this, but we're finding that they're not," said Beth Cahill of the National Womens Health Resource Center.

About 90 percent of all gall bladder surgeries are done laparoscopically, so why not hysterectomy?

"Women are not seeking second opinions; they are going to the gynecologist that delivered their babies because they have that trust in them," she said.

"It makes my blood boil," she says. "It does. I'm outraged about it and that's what fires my passion to get the word out."

And to get the word out she invites doctors to come to Baptist Hospital East in Louisville and learn the procedure.

"What would you want for your wife, or your mom, or your sister, or your best friend?" Warren said. "You would want them to have the least invasive procedure possible."

---

Find out more about the individuals, hospitals and groups featured in our reports:

National Womens Health Resource Center

Dr. Lori Warren

Physician And Allied Healthcare Providers

Baptist Hospital East in Louisville

Women First

Massachusetts General Hospital in Boston

San Diego Medical Center

Ethicon Endo-Surgery

Apollo Endosurgery

Beth Israel Deaconess Medical Center in Boston


© MMVIII, CBS Interactive Inc. All Rights Reserved.

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Add a Comment See all 17 Comments

by klgm326 April 5, 2008 1:27 PM EDT

I''m reading all these harsh comments about laparoscopic supracervical hysterectomy. I''m not sure why, because I had a wonderful surgeon in Atlanta -- Dr. Thomas Lyons! I was out of the surgical center in five hours and in no pain (just a little sore at the three incision sites). We actually stopped by Arby''s for lunch on the way back to the hotel. I was literally back at work teaching school 10 days later! Perhaps my positive experience was due to my incredible surgeon! I, too, wonder why I had to travel four hours to find a surgeon proficient in this technique - in the 21st century! www.thomasllyons.com would be a good place for information.

Reply to this comment

by robinwomb April 4, 2008 11:15 PM EDT

I was sorely disappointed when I saw this. Never mind that abdominal hysterectomies are archaic, what about hysterectomy itself?! There are so many other less expensive, safer, more conservative, equally effective, and organ sparing options out there for women for almost every benign condition of the reproductive organs. Why were none of these mentioned? Never mind the long term consequences of removing functional organs such as the uterus, cervix, ovaries, fallopian tubes.
I had a laparoscopic vaginal assisted hysterectomy 3 years ago and my life has never been the same. I have constant bladder and pelvic floor pain/dysfunction that I never had before, vaginal scarring and numbness, abdominal swelling, and painful ***. I was in so much pain after the hysterectomy that I was in the hospital for three days. I went back to work after 4 weeks but I was nowhere near ready. That was all I was approved for. I shudder at the thought of women working after only one week. No matter how fast, easy, "safe" it gets, hysterectomy is still major surgery that alters a woman''s life. It should be an absolute last resort. Sadly, after 120 years of hysterectomies being performed on women, they have not slowed down a bit, in fact they have increased. Why not put more effort and research into finding the root causes of these reproductive problems so we can find cures and take preventative measures instead of increasing the assembly line of hysterectomy?

Reply to this comment

by msangelica1 April 4, 2008 11:13 PM EDT

Before having my total laparoscopic hysterectomy (TLH), I researched and found that other procedures and alternatives could not be used for my total hysterectomy. Every patient is different and needs to be informed; my doctor and I discussed several other options. We opted for vaginally assisted TLH. My surgery was complicated by several negative factors: the ovaries and colon were bonded to the uterus and endometriosis was present. Also, the uterus wall had visible muscle tissue and lots of annoying fibroids. A previous pap smear came back with unwanted results. My blood pressure was always very high due to stomache and back pain. I was in distress for many months and found no reason to keep any of those defective parts. A week later, I am very happy with the results of my surgery. The doctors and staff did a great job on my TLH surgery!
http://www.ask4ufe.com/common.cfm
http://www.ohanlan.com/total_laparo.htm
http://www.novasure.com/index.cfm
http://www.uptodate.com/patients/content/topic.do?topicKey=wom_issu/4769&title=Menstrual+cycle
http://www.obgynassociates.com/hospitals.html

Reply to this comment

by pschristy April 4, 2008 9:25 PM EDT

Still too invasive. See below:

http://www.reuters.com/article/pressRelease/idUS88512+02-Jan-2008 PRN20080102

also

ask4ufe.com

Paul.

Reply to this comment

by dalerow April 4, 2008 3:49 PM EDT

Your article is good is far as it goes. However, the latest in technology is doing this same laparoscopic procedure through the use of the da Vinci robot. This gives the surgeon much better control of instruments and much better vision of the procedure. This is relatively new but its usage is rapidly growing. To check this out further look at www.intuitivesurgical.com
Dale

Reply to this comment

by minnick8-2009 April 4, 2008 1:58 PM EDT

I had to fight to get my hysterectomy ten years ago because of the current philosophy that they are just not necessary. My insurance avowed the procedure was old-fashioned and were very reluctant to pay. I finally won out and the procedure was done vaginally. There are a number of situations in my life that I have felt, "Free at last, free at last, thank God Almighty, free at last." Those situations were when I ETS''d from the military in 1972, when I got my divorce in 1979, when I finally graduated from college (it took me a long time), when my mother finally passed away after a long illness, and when I finally convinced my insurance company to approve a hysterectomy.

Reply to this comment

by pschristy April 4, 2008 1:32 PM EDT

What I can''t believe is that nobody knows that you don''t have to have your uterus removed at all! Uterine fibroid embolization is 90+% effective. Look it up. I am an MD who performs this procedure and it is almost miraculous how well patients do. Patients are not informed about this option because it is not performed by gynecologists. The real question is not "Are women getting the wrong operation?", it is "Do women need an operation at all?" And the answer is often NO. Look it up.

Reply to this comment

by Pat Stringer April 4, 2008 12:42 PM EDT

What has happened to the vaginal method? I had my uterus (and cervix) removed 40 years ago. I was overnight in the hospital and had an excellent recovery. No outside stitches, no scar, no more pap smears. That''s the way to go.

Reply to this comment

by redhouse93 April 4, 2008 11:44 AM EDT

I had the laproscopic surgery recently. My Dr does this routinely instead of the cut-open method.
What I don''t agree with is 1 hour? 1 week? My surgery took 3 1/2 hours and while I was up and walking around that night, it did take me 5 weeks to recover and I was still having bleeding when I did too much.
Join the real world Dr. Jon LaPook. I should have known you would be a man.

Reply to this comment

by grw1970 April 4, 2008 10:38 AM EDT

The latest isn''t always the greatest. From the day of surgery I have decreased bowel function. No issues prior to surgery. In the past year I have had every dehumanizing and humiliating GI test available, and all any doctor or specialist can say is that I''m structurally normal. Two tests were finally abnormal to document abnormal function. No physician can tell me WHY. I have tried every possible drug/diet. Nothing works. Now the doctors want to remove my colon. The only hypothesis is that I had an abnormal response to the bowel gas used in laparoscopic procedures, which "shocked" my bowels. Hopefully over time it MIGHT improve. I endure daily laxative abuse and fiber manipulation just to get by. I will NEVER submit to another laparoscopic procedure again. I want open procedures where my surgeon can adequately see my insides. I don''t care if the recovery time is longer and it is more invasive. I would rather endure that than what I am going through now.

Reply to this comment

by bakermbakes April 4, 2008 9:47 AM EDT

I had the lap done on 4/26/08.Originally I was going to have the abdominal surgery due to the shape & position of my uterus. I ended up needing more than 1 procedure,so the lap was the best way to go. I think the report that CBS did & the person they interviewed right after her hysterectomy was still on meds & that is why she felt so great.I felt great 5 hours later too,at that point you are still medicated & people need to know that. I had to stay over night in the hospital. I had it done at Metrowest Hospital in Framingham, Mass. My GYN is Dr. A.G. she explained both procedures to myself & my husband. She also explained that there was a chance that she may need to, if anything went wrong to open up the abdomen. I have been home a week now & today I have some pain. I have fibromyalgia so my recovery is a little longer. yes CBS has made it look like you can get up & go the next day,that''s not true. They need to investigate things more before they do a report on something as important as this. Like how is the patients medical history, the condition of their uterus, can the Doctor actually do the surgery lapriscopically? or abdominally. There are so many things that a Doctor needs to look at before making that final,& the patient has the final say in it all. CBS do your home work before doing an article this big.

Reply to this comment

by whitney999 April 4, 2008 1:53 AM EDT

the more I google and read...the more this story is woefully inadequate. There are reasons for the less easy hysterectomy and the many factors involved and levels of this surgery just really need this story to be redone and re broadcast. And I had the lap one so I''m a fan of anything easier....just give all the facts so people don''t get angry for no good reason.

Reply to this comment

by whitney999 April 4, 2008 1:17 AM EDT

I just had the "easy" hysterectomy. Yes, it''s far more tolerable than the old way. I really think though that CBS does a great dis service to tell people that they are back on their feet in a week. For a full hysterectomy, even done with lap technique- one is still healing for 4 to 6 weeks on the inside. Outside incisions heal faster.
Early lifting or heavy movements can cause tearing and ill healing.
And I was told that sometimes if they cannot reach everything due to anatomical positioning then they must cut abdominally.
In fact, I was told that there is more vaginal healing with the lap type hysterectomy. I guess that''s show biz and things have to be miraculous instead of just honest in order to make a great story.
Also, writers should separate uterus removal and full hysterectomy as well as differentiating the complications with the different reasons for the surgery to begin with. Not all reasons are so simple.
I am thankful for the wonderful surgeon who took care of me and used this protocol...just stop Hollywoodizing everything. Objectivity sells just as well. Also some folks are waitresses and have jobs that require a little more rest and post op care.

Reply to this comment

by whitney999 April 4, 2008 1:09 AM EDT

I just had the "easy" hysterectomy. Yes, it''s far more tolerable than the old way. I really think though that CBS does a great dis service to tell people that they are back on their feet in a week. For a full hysterectomy, even done with lap technique- one is still healing for 4 to 6 weeks on the inside. Outside incisions heal faster.
Early lifting or heavy movements can cause tearing and ill healing.
And I was told that sometimes if they cannot reach everything due to anatomical positioning then they must cut abdominally.
In fact, I was told that there is more vaginal healing with the lap type hysterectomy. I guess that''s show biz and things have to be miraculous instead of just honest in order to make a great story.
Also, writers should separate uterus removal and full hysterectomy.

Reply to this comment

by mythoughtsr April 4, 2008 1:03 AM EDT

I had a vaginal hysterectomy and the doctors there and all the ones all my friends and family go to have had laparoscopic ones done. I stayed two nights in the hospital and did very well at home three days later with 3 kids in the house. No incision, no cuts, nothing. The surgery changed my life and is the best thing I could have ever had done.

This doctor is a loon. I don''t know of anyone who has the invasive kind anymore, I know of at least 3 people in the past 6 months who had it done either vaginally or laparoscopically. I think this doctor is full of it. This technique is widely used here and recovery time is minimal.

Reply to this comment

by msangelica1 April 3, 2008 11:50 PM EDT

I had a total laparoscopic hysterectomy (TLH) last Thursday, March 27th, 2008 at Texas Woman''s Hospital in Houston, Texas. What a wonderful surprise; it was a very positive experience and NOT painful. I have 3 tiny holes around my tummy, but no large incision. The surgery is usually 1 or 1.5 hours, but mine took longer since the uterus was bonded to the colon. I woke up feeling much better without the many symptoms from months of fibroid bleeding and endometriosis. I stayed overnight at Woman''s Hospital of Texas (that is a wonderful hospital with warm and caring nurses and staff!). Recovery is a breeze and I''m ready to get back to teaching chemistry in ~2 or 3 weeks. Dr. Cooper in Houston, Texas is my hero! I want to tell every woman about TLH; it''s a great surgical method. This is the link to Ob & G Assoc. in Houston:
http://www.obgynassociates.com/hospitals.html

Reply to this comment

by manypd13 April 3, 2008 10:29 PM EDT

I had my hysterectomy 15 years ago via the laparoscopic technique. It wasn''t totally new then but not widely used. At the time I believe there were only two OB/GYNs that did this in my area. I left the hospital the same day of the surgery and went to St. Thomas five days later on vacation.

Reply to this comment

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[klgm326]

I''m reading all these harsh comments about laparoscopic supracervical hysterectomy. I''m not sure why, because I had a wonderful surgeon in Atlanta -- Dr. Thomas Lyons! I was out of the surgical center in five hours and in no pain (just a little sore at the three incision sites). We actually stopped by Arby''s for lunch on the way back to the hotel. I was literally back at work teaching school 10 days later! Perhaps my positive experience was due to my incredible surgeon! I, too, wonder why I had to travel four hours to find a surgeon proficient in this technique - in the 21st century! www.thomasllyons.com would be a good place for information.

[robinwomb]

I was sorely disappointed when I saw this. Never mind that abdominal hysterectomies are archaic, what about hysterectomy itself?! There are so many other less expensive, safer, more conservative, equally effective, and organ sparing options out there for women for almost every benign condition of the reproductive organs. Why were none of these mentioned? Never mind the long term consequences of removing functional organs such as the uterus, cervix, ovaries, fallopian tubes.
I had a laparoscopic vaginal assisted hysterectomy 3 years ago and my life has never been the same. I have constant bladder and pelvic floor pain/dysfunction that I never had before, vaginal scarring and numbness, abdominal swelling, and painful ***. I was in so much pain after the hysterectomy that I was in the hospital for three days. I went back to work after 4 weeks but I was nowhere near ready. That was all I was approved for. I shudder at the thought of women working after only one week. No matter how fast, easy, "safe" it gets, hysterectomy is still major surgery that alters a woman''s life. It should be an absolute last resort. Sadly, after 120 years of hysterectomies being performed on women, they have not slowed down a bit, in fact they have increased. Why not put more effort and research into finding the root causes of these reproductive problems so we can find cures and take preventative measures instead of increasing the assembly line of hysterectomy?

[msangelica1]

Before having my total laparoscopic hysterectomy (TLH), I researched and found that other procedures and alternatives could not be used for my total hysterectomy. Every patient is different and needs to be informed; my doctor and I discussed several other options. We opted for vaginally assisted TLH. My surgery was complicated by several negative factors: the ovaries and colon were bonded to the uterus and endometriosis was present. Also, the uterus wall had visible muscle tissue and lots of annoying fibroids. A previous pap smear came back with unwanted results. My blood pressure was always very high due to stomache and back pain. I was in distress for many months and found no reason to keep any of those defective parts. A week later, I am very happy with the results of my surgery. The doctors and staff did a great job on my TLH surgery!
http://www.ask4ufe.com/common.cfm
http://www.ohanlan.com/total_laparo.htm
http://www.novasure.com/index.cfm
http://www.uptodate.com/patients/content/topic.do?topicKey=wom_issu/4769&title=Menstrual+cycle
http://www.obgynassociates.com/hospitals.html

[pschristy]

Still too invasive. See below:

http://www.reuters.com/article/pressRelease/idUS88512+02-Jan-2008 PRN20080102

also

ask4ufe.com

Paul.

[dalerow]

Your article is good is far as it goes. However, the latest in technology is doing this same laparoscopic procedure through the use of the da Vinci robot. This gives the surgeon much better control of instruments and much better vision of the procedure. This is relatively new but its usage is rapidly growing. To check this out further look at www.intuitivesurgical.com
Dale

[minnick8-2009]

I had to fight to get my hysterectomy ten years ago because of the current philosophy that they are just not necessary. My insurance avowed the procedure was old-fashioned and were very reluctant to pay. I finally won out and the procedure was done vaginally. There are a number of situations in my life that I have felt, "Free at last, free at last, thank God Almighty, free at last." Those situations were when I ETS''d from the military in 1972, when I got my divorce in 1979, when I finally graduated from college (it took me a long time), when my mother finally passed away after a long illness, and when I finally convinced my insurance company to approve a hysterectomy.

[pschristy]

What I can''t believe is that nobody knows that you don''t have to have your uterus removed at all! Uterine fibroid embolization is 90+% effective. Look it up. I am an MD who performs this procedure and it is almost miraculous how well patients do. Patients are not informed about this option because it is not performed by gynecologists. The real question is not "Are women getting the wrong operation?", it is "Do women need an operation at all?" And the answer is often NO. Look it up.

[Pat Stringer]

What has happened to the vaginal method? I had my uterus (and cervix) removed 40 years ago. I was overnight in the hospital and had an excellent recovery. No outside stitches, no scar, no more pap smears. That''s the way to go.

[redhouse93]

I had the laproscopic surgery recently. My Dr does this routinely instead of the cut-open method.
What I don''t agree with is 1 hour? 1 week? My surgery took 3 1/2 hours and while I was up and walking around that night, it did take me 5 weeks to recover and I was still having bleeding when I did too much.
Join the real world Dr. Jon LaPook. I should have known you would be a man.

[grw1970]

The latest isn''t always the greatest. From the day of surgery I have decreased bowel function. No issues prior to surgery. In the past year I have had every dehumanizing and humiliating GI test available, and all any doctor or specialist can say is that I''m structurally normal. Two tests were finally abnormal to document abnormal function. No physician can tell me WHY. I have tried every possible drug/diet. Nothing works. Now the doctors want to remove my colon. The only hypothesis is that I had an abnormal response to the bowel gas used in laparoscopic procedures, which "shocked" my bowels. Hopefully over time it MIGHT improve. I endure daily laxative abuse and fiber manipulation just to get by. I will NEVER submit to another laparoscopic procedure again. I want open procedures where my surgeon can adequately see my insides. I don''t care if the recovery time is longer and it is more invasive. I would rather endure that than what I am going through now.

[bakermbakes]

I had the lap done on 4/26/08.Originally I was going to have the abdominal surgery due to the shape & position of my uterus. I ended up needing more than 1 procedure,so the lap was the best way to go. I think the report that CBS did & the person they interviewed right after her hysterectomy was still on meds & that is why she felt so great.I felt great 5 hours later too,at that point you are still medicated & people need to know that. I had to stay over night in the hospital. I had it done at Metrowest Hospital in Framingham, Mass. My GYN is Dr. A.G. she explained both procedures to myself & my husband. She also explained that there was a chance that she may need to, if anything went wrong to open up the abdomen. I have been home a week now & today I have some pain. I have fibromyalgia so my recovery is a little longer. yes CBS has made it look like you can get up & go the next day,that''s not true. They need to investigate things more before they do a report on something as important as this. Like how is the patients medical history, the condition of their uterus, can the Doctor actually do the surgery lapriscopically? or abdominally. There are so many things that a Doctor needs to look at before making that final,& the patient has the final say in it all. CBS do your home work before doing an article this big.

[whitney999]

the more I google and read...the more this story is woefully inadequate. There are reasons for the less easy hysterectomy and the many factors involved and levels of this surgery just really need this story to be redone and re broadcast. And I had the lap one so I''m a fan of anything easier....just give all the facts so people don''t get angry for no good reason.

[whitney999]

I just had the "easy" hysterectomy. Yes, it''s far more tolerable than the old way. I really think though that CBS does a great dis service to tell people that they are back on their feet in a week. For a full hysterectomy, even done with lap technique- one is still healing for 4 to 6 weeks on the inside. Outside incisions heal faster.
Early lifting or heavy movements can cause tearing and ill healing.
And I was told that sometimes if they cannot reach everything due to anatomical positioning then they must cut abdominally.
In fact, I was told that there is more vaginal healing with the lap type hysterectomy. I guess that''s show biz and things have to be miraculous instead of just honest in order to make a great story.
Also, writers should separate uterus removal and full hysterectomy as well as differentiating the complications with the different reasons for the surgery to begin with. Not all reasons are so simple.
I am thankful for the wonderful surgeon who took care of me and used this protocol...just stop Hollywoodizing everything. Objectivity sells just as well. Also some folks are waitresses and have jobs that require a little more rest and post op care.

[whitney999]

I just had the "easy" hysterectomy. Yes, it''s far more tolerable than the old way. I really think though that CBS does a great dis service to tell people that they are back on their feet in a week. For a full hysterectomy, even done with lap technique- one is still healing for 4 to 6 weeks on the inside. Outside incisions heal faster.
Early lifting or heavy movements can cause tearing and ill healing.
And I was told that sometimes if they cannot reach everything due to anatomical positioning then they must cut abdominally.
In fact, I was told that there is more vaginal healing with the lap type hysterectomy. I guess that''s show biz and things have to be miraculous instead of just honest in order to make a great story.
Also, writers should separate uterus removal and full hysterectomy.

[mythoughtsr]

I had a vaginal hysterectomy and the doctors there and all the ones all my friends and family go to have had laparoscopic ones done. I stayed two nights in the hospital and did very well at home three days later with 3 kids in the house. No incision, no cuts, nothing. The surgery changed my life and is the best thing I could have ever had done.

This doctor is a loon. I don''t know of anyone who has the invasive kind anymore, I know of at least 3 people in the past 6 months who had it done either vaginally or laparoscopically. I think this doctor is full of it. This technique is widely used here and recovery time is minimal.

[msangelica1]

I had a total laparoscopic hysterectomy (TLH) last Thursday, March 27th, 2008 at Texas Woman''s Hospital in Houston, Texas. What a wonderful surprise; it was a very positive experience and NOT painful. I have 3 tiny holes around my tummy, but no large incision. The surgery is usually 1 or 1.5 hours, but mine took longer since the uterus was bonded to the colon. I woke up feeling much better without the many symptoms from months of fibroid bleeding and endometriosis. I stayed overnight at Woman''s Hospital of Texas (that is a wonderful hospital with warm and caring nurses and staff!). Recovery is a breeze and I''m ready to get back to teaching chemistry in ~2 or 3 weeks. Dr. Cooper in Houston, Texas is my hero! I want to tell every woman about TLH; it''s a great surgical method. This is the link to Ob & G Assoc. in Houston:
http://www.obgynassociates.com/hospitals.html

[manypd13]

I had my hysterectomy 15 years ago via the laparoscopic technique. It wasn''t totally new then but not widely used. At the time I believe there were only two OB/GYNs that did this in my area. I left the hospital the same day of the surgery and went to St. Thomas five days later on vacation.