Personal Health : Hysterectomy Options

Each year in the United States, 650,000 women undergo hysterectomies. When performed in the conventional manner, a hysterectomy usually requires three to five days of hospitalization and a month or more recuperation time. But a newer technique using a laparoscope (a special telescope-like viewing instrument inserted through the abdominal wall) can minimize hospitalization and recovery time.

Here, two experts comment on conventional versus laparoscopic hysterectomies:

Dr. William Parker, chairman of obstetrics and gynecology, Santa Monica Hospital Medical Center; UCLA associate clinical professor of obstetrics and gynecology

“This laparoscopic technique holds a lot of promise. The laparoscope can be used to perform two types of hysterectomy. One is called laparoscopic-assisted vaginal hysterectomy, in which a portion of the uterus is freed through the laparoscope but most of the operation is done through the vagina. The other is called laparoscopic hysterectomy, in which most of the operation is done through the laparoscope.

“Both laparoscopic techniques require about two days of hospitalization and two weeks recovery. The operating time using a laparoscope is somewhat longer than for conventional hysterectomy--about two hours compared with one or 1 1/2. The laparoscopic technique may pose more risk of injury to the ureter.

“A woman should first ask the doctor: Are you trained in laparoscope use? How many of these operations have you done?

“Patients with large fibroid tumors or cancer of the reproductive organs are not good candidates for the laparoscopic technique.”

Dr. Robert Israel, USC professor of obstetrics and gynecology; co-director of Women’s Health Services at the Hospital of the Good Samaritan

“The laparoscope will hopefully reduce the need for conventional abdominal hysterectomies. The laparoscope won’t replace another kind of conventional hysterectomy, the vaginal hysterectomy. Abdominal hysterectomies have more potential for complications.

“If a woman is a candidate for a conventional vaginal hysterectomy, she does not need the laparoscope. But a women who isn’t a candidate for a conventional vaginal approach can benefit from the laparoscopic technique.

“Patients with fibroid tumors might be candidates for the laparoscopic technique.

“The use of the laparoscope to assist vaginal hysterectomy is new. Until we have comparative studies, we won’t know for sure where this approach fits in the total picture.”

Doheny cannot answer mail personally, but will attempt to respond in this column to questions of general interest. Do not telephone. Write to Your Body, View Section, Times Mirror Square, Los Angeles, Calif. 90053.