Women's Health
Women’s Health in 2010: A Shift Toward Minimally Invasive Hysterectomy
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Feb 3, 2010 - 5:48:49 PM

(HealthNewsDigest.com) - Approximately 600,000 hysterectomies (surgical removal of the uterus) are performed annually in the United States, with an estimated 20 million women having had the procedure to date.[i] In fact, one third of U.S. women have had a hysterectomy by age 60.[ii] Market analysts from The Advisory Board (ABCO) predict that we will see a growing trend in 2010 and subsequent years in surgeons performing a minimally invasive surgical procedure called laparoscopic hysterectomy.[iii] The trend toward minimally invasive hysterectomy is likely being driven by the increase in both supply and demand for the procedure. There is an increase in fellowship trained gynecologic surgeons specializing in laparoscopic surgery (supply), as well as women’s increased awareness of their surgical options (demand).

Historically, hysterectomies have been performed through a large incision in the abdominal wall. Like many other invasive surgeries, abdominal hysterectomies can involve fairly extensive recovery periods of up to six weeks for patients. The advent of new technology, however, has made less invasive techniques possible, including vaginal hysterectomies, performed through an incision at the top of the vagina, and laparoscopic hysterectomies, involving a few small incisions in the abdomen through which surgical instruments and a laparoscope are inserted to perform the surgery.[iv]

As the name suggests, the key to laparoscopic surgery is the laparoscope—a medical instrument that can be used to explore areas inside the human body such as the abdomen, gallbladder, colon, kidney, stomach, intestines, pancreas, bladder and spleen, as well as all of the female organs and the prostate in men. The laparoscope itself consists of a miniature video camera attached to the end of a slender telescopic instrument. Its small size allows it to be inserted through a tiny incision in the abdomen, usually at or near the navel, giving the clinician a clear, real-time view inside the abdominal cavity. The images captured by the video camera are streamed live onto a video monitor. In the case of a laparoscopic hysterectomy, the surgeon has a clear and close-up view of the female reproductive organs, and the monitor serves as the viewing field for the surgical procedure. The uterus is detached laparoscopically using surgical instruments that are inserted through other small incisions in the abdomen. The detached organ is then removed through a small incision at the top of the vagina or through the navel area.4

The ABCO predicts that by the end of 2010, 44% of all hysterectomies undertaken in the United States will be performed laparoscopically, and by 2017, this figure is expected to jump to 55%.3 This is good news for women from both a clinical and cosmetic perspective. Since successful laparoscopic hysterectomies require only a few small incisions (usually 0.5–1.5 cm long),[v] they can be less disfiguring than abdominal hysterectomies that require larger incisions and can leave behind unsightly scars.

Despite the prevalence of laparoscopic procedures, open abdominal surgery still remains the most common approach to hysterectomy.[vi] Laparoscopic surgery is much more widely used in procedures such as gallbladder removal and other abdominal surgeries. In fact, according to the National Institute of Health, almost all gallbladder procedures are performed with laparoscopy. [vii] Likewise, laparoscopy is widely used in gastric banding procedures for obesity (100% of the time), tubal ligation for contraceptive purposes (70% of the time) and appendectomy (60% of the time).3 In contrast, some sources indicate that laparoscopic hysterectomy currently accounts for only about 15% of all hysterectomies performed in the United States.7 Other sources cite figures as high as 40%, but all data indicates that the usage rate of laparoscopy for hysterectomies is far lower than its usage rates for other common abdominal procedures.[viii]

A number of opinions have been offered for the slow adoption of laparoscopic hysterectomy. Some observers point to the greater familiarity that OB/GYNs have had with open abdominal surgery based on years of performing abdominal C-sections for women in childbirth.[ix] Others cite the limited training that OB/GYNs receive on new techniques during residency.[x] The physician-patient relationship also plays a role in acceptance rates of laparoscopic hysterectomy. According to Franklin Loffer, MD, of the American Association of Gynecologic Laparoscopists, “Women have a relationship with their OB/GYNs. They trust them and tend to stay loyal to them. That makes OB/GYNs less motivated to change what they are accustomed to doing”.9

Olympus, which incorporates surgical market leader Gyrus ACMI, is a leader in laparoscopic technology and was among the first to pioneer laparoscopic surgery with the introduction of its EndoEYE® video laparoscopes. These videoscopes offer an optimized image via a distally mounted camera chip along with a light-guide cable, both housed inside the scope. The result is a lightweight, slender device that delivers exceptional imaging performance. Recent advancements in EndoEYE technology have incorporated a flexible tip design, which provides an impressive 100° field of view in all four directions, allowing visualization of areas not previously accessible with standard laparoscopes. Gyrus ACMI offers advanced technologies in laparoscopic hysterectomy that enable gynecologists to perform a wide range of surgical procedures with instruments designed to shorten procedure times and help improve patient outcomes.[xi]

In 2009, Olympus formally introduced an advanced technology platform that gives surgeons the ability to perform minimally invasive single-site surgery through the navel. The Olympus portfolio for laparo-endoscopic single-site surgery combines advanced laparoscopic technology, Gyrus’ proprietary PK energy platform and a full line of multifunctional instruments that allow surgeons a new way to observe the anatomy and perform minimally invasive surgeries, including laparoscopic hysterectomy, through the bellybutton.

A hysterectomy is an important decision faced by many women each year. Before making that decision, every woman should understand her surgical treatment options. The American Association of Gynecologic Laparoscopists offers a patient site at www.aagl.org/topics to provide a wealth of information.

About the Author: Manisha Shah-Bugaj is the director of marketing in the Surgical Energy division of Gyrus ACMI, one of the world's leading suppliers of medical visualization and energy systems and now an Olympus company. She oversees strategy and business development in the gynecology and urology market segments for the Surgical Energy business and works closely with surgeons to develop new products to help advance minimally invasive surgery. Manisha earned both her Bachelor’s of engineering and her Master’s of engineering management from Dartmouth College.

[1] Department of Health and Human Services. Centers for Disease Control and Prevention. Women’s Reproductive Health: Hysterectomy. http://www.cdc.gov/reproductivehealth/WomensRH/Hysterectomy.htm. Last reviewed 5/7/09. Accessed 1/17/10.

2 Medline Plus, a service of the National Library of Medicine and the National Institute of Health. Hysterectomy. http://www.nlm.nih.gov/medlineplus/hysterectomy.html. Last updated 1/4/10. Accessed 1/17/10.

3 Bentley F, Hartman J. Future of Surgery: Strategic Forecast and Investment Blueprint. Health Care Advisory Board. 2009:26.

4 The American Association of Gynecologic Laparoscopists. Patient Education Topics: Hysterectomy. www.aagl.org/topics (TREATMENTS>Hysterectomy). Reviewed 3/08. Accessed 1/17/10.

5 American Medical Association. Complete Medical Encyclopedia. Random House Reference. 2003:768-770.

6 Einarsson J, Suzuki Y. Total Laparoscopic Hysterectomy: 10 Steps Toward a Successful Procedure. Clinical Obstetrics and Gynecology. 2009;Winter:2(1):57-64.

7 National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases. National Institute of Health. http://www.digestive.niddk.nih.gov/ddiseases/pubs/gallstones/#6. NIH Publication No. 07-2897. July, 2007. Accessed 1/17/10.

8 Sokol A, Green I. Laparoscopic Hysterectomy. Clinical Obstetrics and Gynecology. 2009;52:304-312.

9 Rosen P. More.com. The Endangered Uterus. http://www.more.com/4488/2382-the-endangered-uterus. Originally published in MORE magazine. December 2008/January 2009. Accessed 1/17/10.

10 Reich H. Total Laparoscopic Hysterectomy: Indications, Techniques, and Outcomes. Current Opinions in Obstetrics and Gynecology. 2007;19:337-344.

11 On February 1, 2008, Olympus Corporation completed the acquisition of Gyrus Group, PLC, a global medical device business specializing in minimally invasive surgery, including leading visualization and tissue management systems.

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