Time has passed; has anything changed?

I just wanted to stop by to let you all know that although most of the posts here are a few years old, now, that doesn't mean they're outdated. I do review them from time to time to make sure the information contained in them hasn't been superseded by anything new and different.

Basically, the surgery remains the same and how we prepare and recover from it are still pretty much unchanged. If anything, there's more emphasis on the so-called minimally-invasive surgeries today, and while they can be good in some situations, we need to be careful to separate marketing-speak from what's in our own best interests.

If there's one thing that's changed in the past five years, it's been the number of surgery centers that have purchased robotic surgical equipment. But this carries an unfortunate cost for women. Although the robotic surgery is touted as being safer, less invasive, more precise and, especially, much faster to recover from, that's not actually been seen in use. In fact, according to a Reuter's news article that came out in 2013:

the tool didn't reduce complications linked to hysterectomy or otherwise improve women's outlook after surgery, researchers found. And it raised the cost of the procedure by almost one-third.

In fact, researchers who analyzed records of a large number of surgeries during the previous few years found that

The only advantage to robotic surgery was a drop in the proportion of women staying longer than two days in the hospital

Additionally, other studies have found that the surgery itself takes longer and in fact results in more pain than a conventional laparoscopic surgery. (source)

So why are these surgeries being promoted? This is an expensive piece of equipment and every moment when it's sitting unused, it's failing to return on that investment with profits for the medical center that purchased it. While robotic surgery does improve outcomes in some surgeries, a hyst is not one of those. That enticing advertising, then, is all about profits and not about your health.

Another interesting aspect to recent surgical techniques that reduce the size of abdominal or vaginal incisions is that the uterus has to be essentially ground into small particles before it can be removed via these tiny incisions and the tools that fit into them. Called "morcellation," this procedure is done via special tools called, not surprisingly, morcellator devices.

Since their introduction, there has been a worrisome trend of complications following on their use, especially when fibroids are present. In addition to damage to surrounding organs, the procedure appears to be quite effective at spreading previously-undetected malignant tissue to locations outside the uterus. This risk is now considered so well-demonstrated that hospitals are discontinuing the use of this tool in hysterectomies and other uterine surgeries and the major manufacturer of the devices has suspended their sale (source). Clearly, this is something to check with your surgeon about: unlike robots, this is not something that is advertised and you may not be routinely informed that your surgeon plans to employ this technique.

But basically, while modern surgeries may result in smaller incisions, the internal healing remains the same. In fact, we see more women mystified about how long it's taking to recover than we did when abdominal incisions were the major route. I think that there's a real push to be "back to normal" within days if not weeks of surgery, even when women have to exhaust themselves to do so (and reduce the quality of their healing besides).

Is there still a role for traditional abdominal incision hysts? Oh yes, and a woman shouldn't feel like a failure because she doesn't qualify for a minimally-invasive procedure. Any time there's risk of cancer or actual confirmed cancer, we face requiring a radical hysterectomy, a much more extensive procedure that in part relies upon our surgeon's clear view of the entire abdominal contents. And for fibroids, well, given the risks associated with breaking up a fibroid-filled uterus, I think I personally would still opt for an incision that allows a uterus to be removed essentially whole.

Other than this, the only other major trend has been the ongoing decrease of hospital stays after hysts. To some degree, this is a result of the more minimal procedures; it's certainly also due to insurance companies not wanting to cover the costs of an extra day or two of monitoring and drugs. Additionally, it can in fact be considered a reflection of the fact that it's to some extent more dangerous to be in a hospital, exposed to infections carried by others, than to be at home. So long as we are clear on what to report to our doctors and take care to get the necessary fluids and walking/repositioning exercise, there's rarely anything magical about being in hospital that we cannot do for ourselves. The most important aspect of safety in early recovery is recognizing complications, most typically those of bleeding or early infection, and reporting them promptly. Remember: if you're in doubt, it's always better to call than to wait and require emergency intervention.

And finally, the only other piece of news I can offer is that our old Yahoo message list is long gone. But that doesn't mean that women's need to discuss their surgeries and ask questions is over and done with. Nope: we all can use some company at a time like this. So Framboise, over at the Survivor's Guide to Surgical Menopause, has opened their discussions to those who are planning or who have had hysts of any kind. Feel free to join them and benefit from discussions with other women who have been where you are now.