New, Less-Invasive Hysterectomy Means Less Pain and Quicker Recovery

      FORT WORTH, Texas - The lack of pain is what most surprised Mikala Bradley of Fort Worth, the morning after her recent hysterectomy.

      ``I haven''t had anything for pain this morning,'' she said from her hospital bed at Harris Methodist H.E.B. ``Of course, I haven''t gotten out of bed yet, but I was expecting it to be a lot worse. I don''t hurt at all.''

      Severe pelvic pain and excessive bleeding led doctors to recommend a hysterectomy for Bradley, 28, more than seven years ago, but she says she was determined to have a baby first.

      Shortly after the birth of her son three years ago, she began seriously considering a hysterectomy to get rid of painful fibroid tumors, but she was concerned about the long recovery and time off from work that she remembered from her mother''s hysterectomy.

      This summer, her doctor''s nurse told her about laparoscopic supracervical hysterectomy, a procedure in which large fibroid tumors and the uterus itself can be removed through small laparoscopic incisions or punctures in the abdomen while leaving the cervix intact.

      A new surgical instrument, called a ``tissue morcellator,'' makes it possible to cut up and remove large, calcified fibroids and other dense tissue through one of the tubes inserted into three or four tiny incisions in the abdomen for laparoscopic surgery.

      Surgeons take out benign tumors and cysts as well as the uterus, fallopian tubes and ovaries through the tube - without removing the cervix.

      The laparoscopic procedure reduces pain and trauma to the body as well as recovery time, says Dr. Stephen Farmer, the gynecologist who performed Bradley''s surgery. He is one of at least five Tarrant County doctors now doing the minimally invasive hysterectomies.

      ``The biggest thing that has surprised me is the lack of pain after surgery,'' Farmer says. ``The nurses began asking why these patients weren''t wanting more pain medication. The reason is that the more cutting and tissue manipulation you do, the more discomfort there is afterward. With this, there is less cutting and less moving organs and tissue around.''

      Laparoscopes have been used in what are known as laparoscopically assisted vaginal hysterectomies (LAVHs) for about 10 years, but with the older procedure, the uterus and cervix as well as benign tumors are removed through an incision in the interior of the vagina, rather than through one of the small incisions in the abdomen.

      The laparoscope has a fiber-optic light and a magnifying video camera to see inside the abdomen and guide the surgeon in locating and cutting away the unwanted tissue.

      Despite availability of the less-invasive procedures, more than half of the nearly 600,000 hysterectomies performed in this country each year are still done with a 4- to 6-inch abdominal incision through layers of fat, muscle and other tissue. Recovery time is four to six weeks, and patients cannot drive a car for two weeks.

      In addition to quicker recovery and less pain and bleeding, the newest procedure has several potential benefits including preservation of the cervix, which many women feel contributes to sexual pleasure and which is important to prevent vaginal prolapse and stress incontinence.

      ``It does not destroy the normal architecture of the pelvis, so there are fewer complications,'' Farmer says.

      The laparoscopic supracervical hysterectomy is billed as ``the painless hysterectomy,'' says Dr. Joseph McWherter, a Fort Worth gynecologist who has done about 65 of the procedures in the past couple of years.

      ``I look at it as holistic. You''re not taking out something that should be there (just to remove what shouldn''t be there),'' McWherter says.

      ``The morcellator really makes the difference. I''ve taken out a 10-centimeter fibroid this way. It leaves the cervix, so the vagina is well-supported, and it preserves the nerves of the cervix that are important to the sexual erogenous zone,'' McWherter says.

      ``Also, you are not traumatizing the bladder with this procedure. Studies show that 40 to 60 percent of patients complain of urine leakage after the cervix is removed,'' he says.

      With a vaginal hysterectomy, whether or not it is laparoscopically assisted, patients spend one to two days in the hospital and have no visible scar. Most go back to work in three to four weeks.

      ``With LSH, the patient can go home that evening or the next morning, resume intercourse in one week and drive again in a week and go back to work in about two weeks. I have known patients to go back to work in one week,'' McWherter says.

      Doctors say the new procedure should not be done to remove malignant tumors or pre-cancerous lesions.

      ``Women who are candidates should only have benign disease and normal Pap smears,'' McWherter says. ``But you''re looking at a procedure that for many women can minimize pain and disfigurement and recovery time as well as the possible long-term complications that can arise. We can also do any bladder repairs that are needed - all through those small incisions.''

      Lisa Hansen, 40, chose LSH because those small incisions, known as ``band-aid surgery,'' mean less blood loss as well as quick recovery.

      ``I had uterine fibroids and dysfunctional bleeding,'' explains Hansen, Farmer''s nurse. ``I was anemic. My hemoglobin (red blood cells that carry oxygen) had dropped to six, and I was so fatigued. I didn''t want to take a chance on losing any more blood than absolutely necessary,'' Hansen says. ``There is a lot of bleeding when you remove the cervix intact and pull the uterus down through the vagina. My choices were limited because I didn''t want to have a blood transfusion, and I didn''t have the blood to lose.''

      Also, Hansen says she did not want to take any more time off from work than absolutely necessary.

      ``I''m not a person who can be down a long period of time. For this, your entire down time is about two weeks, unless your job involves a lot of heavy lifting. Most are going back after 14 days. I''m selling this to anyone who asks. I should have done this a long time ago. I feel like a million bucks,'' Hansen says.

      ``I think in a few years, this will be the most common procedure for a hysterectomy because of patient demand,'' she says.

c.2000 Fort Worth Star-Telegram