NORTH ADAMS -- Planning for a hysterectomy used to include taking six weeks off from work, but advances in technology have cut recovery time for women in half.
While recovery time is dependent on the individual, patients of Northern Berkshire OB/GYN who undergo a laparoscopic hysterectomy, as opposed to the more invasive open abdominal hysterectomy, have an average recovery rate of three weeks, according to Dr. Veronica Del Riccio, an obstetrician and gynecologist with the practice.
A hysterectomy -- the removal of a woman's uterus and, in most cases, the cervix -- is performed for numerous reasons, including abnormal vaginal bleeding, endometriosis and chronic pelvic pain.
"We're seeing the number of open abdominal hysterectomies decreasing as more and more gynecological surgeons are being trained to perform laparoscopic hysterectomies," Del Riccio said Monday during an interview about the procedure at North Adams Regional Hospital. "It's a minimally invasive procedure that requires three 5 millimeter incisions on the abdomen, as opposed to having open surgery."
The surgery is being favored more and more by women in their 40s and 50s, who are pre-menopausal and experiencing heavy menstrual bleeding, chronic pelvic pain or bleeding outside of their menstrual cycles. The procedure, which is covered by insurance, is considered only after exhausting alternative methods, such as the use of birth control to control non-cyclical menstrual bleeding or ablation, the burning of the uterine lining.
"It's not the 1930s. Women don't have to suffer with annoying, heavy bleeding that impedes on daily living or chronic pain," she said. "Many women also have the misconception that they need to have their period. Once a woman is done having children, there is no need for the uterus. It can be removed. We will leave the ovaries in, as they are the source of a woman's estrogen hormones, unless she is at-risk for ovarian cancer or post-menopause, when ovarian cancer risks increase."
While gynecological surgeons like Del Riccio still prefer to perform vaginal hysterectomies -- removal of the uterus through the vagina without any abdominal cutting -- when possible, laparoscopic surgery is beginning to become more common.
The traditional open abdominal procedure requires a 5- to 7-inch cut into the abdomen and as long as a three- to five-day stay in the hospital. With the laparoscopic procedure, women stay at the hospital overnight, she said.
"There are over 600,000 hysterectomies performed in the United States each year," Del Riccio said. "It's always a goal to treat a patient in the most minimally invasive way, with the shortest recovery time and least amount of pain. Vaginal hysterectomies still have the quickest recovery rate, but patients have to meet certain criteria for it: prolapse of the uterus and not too many prior abdominal surgeries."
During a laparoscopic hysterectomy, the patient's abdomen is filled with carbon dioxide, as a means to create space between the organs surrounding the uterus, and a 5 millimeter incision for the laparoscopic camera is made at the belly button. Surgeons also make two 5 millimeter incisions on the right and left of the lower abdomen for insertion of small surgical tools. The surgeon performs the operation from outside of the body, using a video screen to view the internal procedure.
"We work with patients to determine which procedure is best for them," Del Riccio said. "In patients who have had multiple abdominal surgeries, the scar tissue may be too much and we would need to do an open abdominal hysterectomy. "
While the practice performs laparoscopic hysterectomies, it does not perform robot-assisted hysterectomies, which utilize a sophisticated robotic system of surgical tools. The closest hospital to use the technology is Berkshire Medical Center.
"We have patients who want to have the newest and latest surgical techniques, but I always encourage patients to ask their physicians about the benefits and their training," said Del Riccio, who is trained in both laparoscopic and robotic-assisted laparoscopic hysterectomies.
The main difference, besides the addition of the robotic tools, is the way a patient is tilted during the operation -- the robotic-assisted surgery requires a greater incline.
"Studies are showing there is really no difference in the recovery time. There is the same post-operation experience and same return-to-work time," she said.
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