In 1980 things were very different. Only 35 percent of women were working outside the home, shoulders pads were popular, MTV did not exist yet and 75 percent of hysterectomies were done abdominally (through a large incision, similar to a cesarean section incision). A lot has changed since then.Hysterectomy (removal of the uterus/cervix) is still the second most common surgery performed on women today, behind only Cesarean sections. More than 600,000 women undergo this procedure in the U.S. every year. By the age 60, one-third of women will have undergone a hysterectomy.
While the numbers of women who have the procedure remains high, how it’s done and the process of recovery has radically changed.
The trend in hysterectomy since the 1980s has been to move toward minimally invasive techniques. Up to that point, the only minimally invasive option was a vaginal hysterectomy (instead of a large abdominal incision, the procedure is done exclusively through the vagina). A vaginal hysterectomy allows for a quicker recovery time; however, physicians are only able to perform this procedure safely on a small number of patients.
There’s been a large demand for a procedure that could be performed on a wider patient population than vaginal hysterectomy. This was driven by the needs of patients.
It’s not feasible for most women to be in the hospital several days and then on strict limitations for several weeks after surgery. Patients needed options that would take care of the problem and allow them to get back to their busy lives and families sooner.
Surgeries transitioned from the abdominal approach to less invasive laparoscopy. This type of surgery is done using small instruments through incisions measuring in the millimeters. Laparoscopy was a game changer. OB-Gyns quickly transitioned to this new technology because of the obvious benefit for their patients. The minimally invasive procedure has a shorter recovery time with less blood loss and fewer issues with infection and pain.
In the 2000s, we took another huge step forward when robotics were introduced. Some patients may imagine their surgery being performed by Johnny 5 from the movie Short Circuit or maybe Wall-E. Robotic surgery actually involves a surgeon sitting at a console next to the patient. The robot is a precision a tool the surgeon controls throughout the entire procedure. The surgeon’s tool can move in 360 degrees and offer much more control than the inflexible instruments used in laparoscopy.
The visualization that allows the surgeon to see went from 2-D to high-definition 3-D. Physicians are now able to operate with absolute precision through incisions about the width of a pencil. As an example of the power of the technology, surgeons using robotic technology could successfully peel the skin off of a grape leaving the grape intact. For many doctors, the visualization difference is similar to Dorothy stepping out of her aunt’s house and seeing the world in color for the first time.
For patients, robotic surgery represents another huge leap in improved care. Patients are now able to go home the same day as their surgery and recover at home. Most patients are not in pain, so narcotics aren’t used after the first few post-operative days. Even more impressive, most women are back to work with in 2-3 weeks.
Because of the precision of the robotic surgery hysterectomies, the procedure is now being offered to women fighting cancer. The faster recovery time is especially important to this group of patients because it means moving on to their next stage of treatment even quicker.
Not only does robotics allow surgeons to offer a hysterectomy to a wider scope of patients, the quick recovery time allows more patients to fit the procedure into their lives.
Today, almost 40% of hysterectomies are done robotically. As we look forward there are even more exciting breakthroughs coming. The next step is “scarless” surgery, where the entire procedure is performed through a small, almost invisible incision hidden inside the belly button. Single site surgery seemed like science fiction not that long ago, but this surgery is being performed with great outcomes now.
We have come a long way since the 1980s. The vast improvements made in patient safety and comfort make it safe to say that we won’t go back to the days of abdominal hysterectomies. Unfortunately we may not have seen the last of shoulder pads.
If you need a hysterectomy, your doctor will discuss what options will be best for you.