Hysterectomy: Laparoscopic Hysterectomy
Guest: Dr. David Soper – Obstetrics/Gynecology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. David Soper who is professor of OB/GYN here at the Medical University of South Carolina. Dr. Soper, you are involved in some very interesting work with a new procedure for hysterectomy. What is that procedure?
Dr. David Soper: Linda, it is really exciting right now to be a gynecologist and a gynecologic surgeon. In the past, when we needed to perform hysterectomy in women, we always had to make either a large incision on the anterior abdominal wall which meant the patient was in the hospital for two or three days and then had at least six weeks of recovery. Or, if the uterus was smaller, we were able to do vaginal hysterectomy. But, even with vaginal hysterectomy, which does not involve any incisions on the abdomen, the pulling of the uterus through the vagina gives the patient more postoperative discomfort and the healing still takes up to a month or so, not as bad as abdominal hysterectomy but still some prolonged healing.
Now we can offer laparoscopic hysterectomy and most of these laparoscopic hysterectomies are done with leaving the cervix behind. Now, the benefit of laparoscopic hysterectomy is you have essentially three small puncture wounds on the anterior abdominal wall. Even with very large uteruses, the size that even would be able to be palpated up to the umbilicus, we are able to remove the vasculature laparoscopically, come across the isthmus of the cervix, leaving the cervix behind and all the support of the top of the vagina. Additionally, because we do not enter the vagina, there is essentially no risk for postoperative infection.
Dr. Linda Austin: Laparoscopic is a word that doctors use a lot. I bet there are a lot of people who do not understand quite what laparoscopy is. Can you describe it, what does it look like, what happens?
Dr. David Soper: The laparoscope is a telescope. We make an incision beneath the belly button that is about 10 mm, or about a half of an inch long. Then we make two other incisions that are about the size of a pencil just lateral to the belly button, on the sides. We are able, through the telescope, which goes beneath the belly button, to see the entire pelvis and the pelvic organs and the uterus. Then, with our accessory probes, we are able to put in our instrumentation that allows us to coagulate the blood vessels that feed the uterus and to cut the uterus off the cervix. Then, we have a very special instrument, called a morcellator, which removes the uterus in strips.
Dr. Linda Austin: In tiny little morsels, so to speak?
Dr. David Soper: That is right. That, of course goes to pathology for pathological interpretation. The beauty is that when you see a patient after laparoscopic supracervical hysterectomy, it is like they almost did not have surgery. They have a smile on their face. They are not wiped out like you see patients who have had abdominal hysterectomies or even vaginal hysterectomies. They literally could be done as outpatients.
Dr. Linda Austin: Are they done outpatient?
Dr. David Soper: We have done a couple as outpatients. For the most part, we keep people overnight just to make sure that their pain is under control, and they almost always go home the following morning.
Dr. Linda Austin: What are complications of that procedure?
Dr. David Soper: Well, the complications of laparoscopic hysterectomy are the same of any kind of surgery, so, bleeding, infection and injury to the surrounding structures. But, because we do the operation with visualizing the anatomy with a telescope, any bleeding that we see looks to be much more than it really is. So, we lose a fraction of the blood that we would normally lose with abdominal hysterectomy.
Dr. Linda Austin: Is this a procedure that is being done all across the country?
Dr. David Soper. It is. Fortunately, we are also able to teach residents here at the medical university this technology. They, then, will go out and teach their new partners how to do it and, hopefully, populate South Carolina and the rest of the country. I think this is a real advance for women who actually end up needing this procedure.
Dr. Linda Austin: Is there anyone, or any type of patient, for whom this is not a good option?
Dr. David Soper: Patients that have malignancy, particularly malignancies that have spread, are probably not good candidates for laparoscopic removal. But, it really depends on the skill of the surgeon, and even some malignancies, I think, can be treated laparoscopically.
Dr. Linda Austin: Dr. David Soper, thank you so much for this information. It is really an exciting development for women.
Dr. David Soper: Thank you.
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