In his February editorial, “Minimally invasive hysterectomy: We are at the tipping point,” Dr. Barbieri asked for feedback from readers on their experiences with hysterectomy. I am a general ObGyn practicing in a predominantly blue-collar city of about 70,000 people. I have been performing laparoscopic supracervical hysterectomies (LSH) since 1999. During that period, operative time has decreased from about 75 minutes to approximately 35 minutes, with the major variant being uterine volume. The largest uterus I have removed via LSH exceeded 1,200 g.
I have been amazed by the speed of recovery, with the vast majority of patients returning to full duties within 2 weeks, some as early as 5 days. A handful of women have asked to be discharged home the same day as the operation, and have done quite well. I believe total laparoscopic hysterectomies are an exercise in futility because the expense equals or exceeds that of LSH procedures and the recovery is essentially the same as total vaginal hysterectomy (4 to 8 weeks).
LSH has become my technique of choice. In 2005, roughly 80% (40) of my hysterectomies were laparoscopic supracervical procedures (total vaginal hysterectomy=15%; total abdominal hysterectomy=5%). I exclude patients who may have malignant conditions, abnormal Pap smears within the previous 3 years, symptomatic pelvic relaxation, or pain of unknown cause.
Although the learning curve for this technique is moderately steep and the initial cost is no doubt higher than for total vaginal or total abdominal hysterectomy, I believe the speed of recovery and minimal morbidity make it superior in most cases.
Rick L. Evans, MD
Burlington, NC