Health Topics

Welcome to the Future: Not Your Mother’s Hysterectomy

Who looks forward to a trip to the gynecologist?

Treatment for Gynecologic Disorders

A visit to the gynecologist can be much more overwhelming for women who seek treatment beyond the annual exam – when gynecologic issues are causing painful or embarrassing problems. But treatment of gynecologic disorders has advanced far beyond abdominal hysterectomies once considered standard care. Rapid improvements in technology, including minimally invasive procedures and greater use of robotics, are reducing pain and improving the outcome for most women seeking care.

Scopes revolutionized treatment

Gynecologic surgeons were among the first to adopt laparoscopy, a technology introduced more than 20 years ago that opened the door to many minimally invasive procedures. Surgeries that previously required opening the abdomen could be done through tiny incisions. A scope inserted through one incision provides the surgeon with a clear view, and tiny instruments placed through additional incisions are manipulated to complete a variety of procedures. Surgeries such as total and partial hysterectomy, removal of tubes and ovaries, removal of uterine fibroids and repairs for pelvic organ prolapse can be completed using the laparoscope. Instead of spending three to five days in the hospital for surgery, patients can go home the same day or the next day.

Most women are relieved to hear that they can come in, have a procedure and recover at home after a few hours. But beyond the hospital stay, patients heal faster, have fewer infections and get back to their usual activities much more quickly with minimally invasive procedures than they do with traditional abdominal surgery.

Robots are out of the lab

More recently, large centers like Cleveland Clinic have added robots to overcome some of the limitations of standard laparoscopy. For example, while surgeons only have a two-dimensional view with laparoscopy, robotics provides a full, three-dimensional view. And whereas conventional laparoscopic instruments can just open and close, robots allow more degrees of movement, mirroring the actual wrist movements of the surgeon during open surgery. Besides the main campus, Cleveland Clinic gynecologists are now using robots at Hillcrest and Fairview hospitals for some procedures. New modifications are taking the technology a step further, using innovative equipment that gives the surgeon the ability to use just one opening in the abdomen to complete procedures. The single incision is made in the belly button, leaving no visible scar.

No cutting required

For many procedures, I recommend that women consider vaginal surgery. The lowest “tech” and with the fewest gadgets, vaginal surgery is sometimes overlooked as an option. But a good vaginal surgeon can do many procedures through the vagina that other surgeons would consider opening the abdomen to complete including hysterectomy, removal of tubes and ovaries, and various treatments for pelvic organ prolapse and urinary incontinence. Additionally, an instrument called a hysteroscope, a thin lighted camera, is inserted into the vagina to give the surgeon a view of the cervix and the inside of the uterus. Instruments passed through the hysteroscope can be used to remove polyps and fibroids, and for sterilization. Studies universally show that if a procedure can be completed vaginally, that’s the safest route.

Unique set of skills

Laparoscopic, robotic and vaginal procedures each require specific skills and advanced training. Not every gynecologist is comfortable with every procedure. With so many approaches available, it’s vital that you choose a physician who can discuss the benefits and risks of each option. One size certainly does not fit all! Select a surgeon you feel comfortable talking with so that you can make an informed decision.

For more information on the leading care and the latest advances in gynecological cancer treatment, download the Free Gynecological Cancer Treatment Guide.

- Beri Ridgeway, MD

Beri Ridgeway, MD, is Chief of Staff of Cleveland Clinic. She joined the Cleveland Clinic professional staff in 2009. Previously, she served as Associate Chief of Staff, Institute Chair of the Obstetrics, Gynecology, and Women’s Health Institute and was the inaugural academic chair for the Cleveland Clinic Lerner College of Medicine Department of Obstetrics, Gynecology, and Reproductive Biology.