Hysterectomies: Your Questions Answered

(CBS)  On the CBS Evening News Thursday, CBS News medical correspondent Dr. Jon LaPook had a report featuring Dr. Lori Warren, a gynecologic surgeon. She believes strongly in a new way to do hysterectomies. Dr. Warren says laparoscopic hysterectomies dramatically reduce the invasiveness and pain involved, as well as the length and difficulty of recovery -- yet most doctors still use the standard method of performing the procedure.

After the report, Drs. LaPook and Warren invited questions from viewers about hysterectomies, and the response was overwhelming. So, they chose to address the most frequently-asked questions. These answers are meant as general guidelines and are NOT intended as individual medical advice. Any medical questions and decisions should be addressed by your physicians. Thank you so much for all your questions and comments.

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Q-&-A
This is based on questions submitted after the segment on Laparoscopic Hysterectomy that aired on the CBS Evening News with Katie Couric on Thursday, April 3, 2008.

By Dr. Lori Warren and Dr. Jon LaPook

Q: What are the factors that might affect a patient's suitability for laparoscopic surgery?

A: The segment was meant to report on the large numbers of abdominal hysterectomies that might be able to be done by laparoscopic, less invasive approaches. But not all patients are candidates for laparoscopic hysterectomy. Other options include uterine artery embolization, vaginal hysterectomy, and the traditional abdominal hysterectomy. Some of the reasons that might prevent a laparoscopic approach include:
-- cancer
-- a uterus that is just too big because of benign growths called fibroids
-- severe endometriosis
-- severe scar tissue formation (adhesions) from previous surgery
-- ovarian growths or abnormalities preventing a laparoscopic approach

Q: How does the laparoscopy compare to having the procedure done vaginally?

A: Vaginal hysterectomy is an excellent, minimally invasive surgery.

Q: How do I find a physician who can perform a hysterectomy laparoscopically?

A: The people to start with are your personal physicians. You can also call the hospitals in your area and ask for referrals.

Q: When do I know if my uterus is too big for laparoscopic hysterectomy?

A: If your surgeon does laparoscopic surgery for fibroid tumors, you should follow the doctor's recommendation on what he or she feels comfortable doing with this approach, or seek a second opinion.

Q: Does a laporoscopic hysterectomy sacrifice visual detection of possible cancer?

A: Visualization is actually magnified with a laparoscope. Many gynecological oncologists (cancer specialists) are offering laparoscopic approaches even when there is known cancer. But if cancer is a concern, your doctor may think an open incision (laparotomy) is a better choice.

Q: Can this surgery be dangerous?

A: Yes. Risks go along with every surgical procedure. Some of the most dangerous risks of laparoscopic hysterectomy include (but are not limited to):

-- bleeding
-- infection
-- damage to other structures in the abdomen and pelvis
-- death

Q: With the laparoscopic approach, can the ovaries be removed at the same time as the uterus?

A: Yes.

Q: Should a patient consider fibroid embolization before hysterectomy?

A: Instead of a hysterectomy, uterine artery embolization is an excellent option to consider for treatment of fibroids.

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As always, answers to viewers' questions and any other content and information posted on this Web site are intended only to educate the public on medical topics. This Web site is not designed to, nor does it provide medical advice, and is not intended to be a substitute for professional medical advice. Don't rely on information on this Web site in place of seeking professional medical advice, nor disregard or delay obtaining professional medical advice because of any information contained on this Web site. Do discuss any information you read on this Web site that you believe may be helpful with your professional medical adviser. Dr. Jon LaPook, Dr. Lori Warren and CBS shall not be liable for any errors or omissions in the information presented on this Web site, nor liable for any damages resulting in whole or in part from any person's use of, decision made or action taken in reliance on such information.