Types of Hysterectomies

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Types of Hysterectomies

• Total abdominal hysterectomy
• Total vaginal hysterectomy
• Laparoscopic assisted vaginal hysterectomy
• Laparoscopic hysterectomy
• Laparoscopic Supracervical hysterectomy

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Outcomes Comparison
90 of AUB patients prefer treatments that are
painless, require no large incision and allow a
quick recovery. 4
1 Brumsted JR, Blackman JA, et.al., Fertility and
Sterility, Vol. 652, 1996 2 Dwyer,
ibid 3 Brooks, PG, et.al., Journal of
Reproductive Medicine, Vol. 39, No. 10, October
1994, Rand Corporation 4 RAND Institute,
AAGL 9/97
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Long-Term Patient Outcomes Comparison
Supracervical
Long-term
Abdominal
SMART Procedure
OPERA Procedure
Experience
Hysterectomy
Hysterectomy

100
100
85
Reproductive
Complete /
Potential
Near Complete
Maintained
Absence of
Bleeding
10
15
Subsequent
10
Procedures
40 Increase
No
No
Risk of
Incontinence
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AUB Life-Table Analysis (N62)

• FU (menopause)N No further surgery ()
• 1 49 25 100 Global
• 2 48 16 100 Global
• 3 47 14 91.3 R/A(?cryo)
• 4 46 3 91.3 R/A(?cryo)
• 5 45 1 91.3 R/A Fib/Adeno
• 6 44 0 91.3 R/A SCH
• 7 43 2 73.0 SCH SCH
• 8 42 2 48.6 SCH SCH

Derman et al. Obstet Gynecol 199159-77.
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Alternatives to hysterectomy

• Supracervical hysterectomy
• Ablation of the endometrium
• Resection/ablation in Operating room
• Versa Point
• Electric loop, any instrument company
• Cryoablation
• Gynecare tri-wire loop with morcellator
• Yag Laser
• Pre-menopause GnRH analog therapy add-back

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Global Ablation Technique Equipment

• Thermal Balloon 170-190F for 8-10 min
• ThermaChoice (Gynecare)
• Cavaterm
• Cryo-ablation
• Soprano (Gynecare)
• Bipolar ? 2 min exposure
• Novacept
• Heated fluid 70C for 3-4 min (local anesthesia)
• EnAbl (Innerdyne/U.S. Surgical)
• Radiofrequency balloon
• Vesta/DUB (Vesta Medical)
• Photodynamic Therapy
• Photofrin II
• Microwaves 8mm probe 2 min 12 sec

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Indications for hysterectomy

• Endometriosis
• Abnormal uterine bleeding
• Fibroids
• Pelvic inflammatory disease
• Cancer of uterus, tubes or ovaries
• Severe pelvic adhesions
• Bilateral ovarian pathology
• Adenomyosis
• Pelvic congestion syndrome
• Intractable, recurrent dysmenorrhea or
  metrorrhagia
• Uterine anomalies
• Uterine prolapse
• Recurrent intrauterine polyps
• Uterine perforation
• Mentally retarded patient with no hygiene control
• Pregnancy
• Placenta increta, percreta, or acreta
• Atonic uterus
• Uterine perforation