Hysterectomy procedures by James Purdy MD FACOG
Dr. Purdy performs the following procedures with and without removal of the tube and ovaries. Since December 9, 2008, most of the hysterectomies performed have been robotic assisted hysterectomy due to decreased hospital stay (one day), decreased patient discomfort and decreased blood loss and as a result, faster recovery from surgery. Rush Hospital was the first in the southeast region of the United States to place in surgical use the newest generation of the Intuitive Surgical robotic system called the Xi model.
Hysterectomy is the surgical removal of part or all of the uterus. Subtotal hysterectomy removes only the body (fundus) of the uterus and not the cervix. Total hysterectomy (the most frequent hysterectomy procedure) removes the cervix and the body (fundus) of the uterus. It is the second most common major surgery among women of child-bearing age. Over 600,000 hysterectomies are performed annually.
Hysterectomy is performed to treat the following pelvic or uterine symptoms/conditions:
Dr. Purdy makes an incision (cut) through the skin and tissue in the lower abdomen to reach the uterus. The incision may be vertical or horizontal. Abdominal hysterectomy requires a longer healing time than vaginal or laparoscopic surgery.
This type of hysterectomy allows a unrestricterd view and access for Dr. Purdy of the uterus and other organs during the operation. Dr. Purdy would suggest this procedure if there are large tumors, if cancer may be present. or the uterus with fibroids is very large - greater than 20 week size uterus
Total Vaginal Hysterectomy (TVH):
Dr. Purdy removes the uterus and cervix (total) through the vagina. There is no abdominal incision. Recovery is faster and less uncomfortable.
Laparoscopic Assisted Vaginal Hysterectomy (LAVH):
With laparoscopically assisted vaginal hysterectomy (LAVH), Dr. Purdy removes the uterus through the vagina. LAVH involves the use of a small laparoscope connected to a 2 D high resolution video camera . The device is placed into the abdomen through a small incision. The incision is called a surgiport ranging in size from 5 mm - 8 mm to 12 mm in diameter Dr. Purdy views the actual surgery on a screen while performing the surgery.
Additional small incisions (surgiports) are made in the abdomen to assist the surgery. The uterus is removed through the vagina. Recovery from LAVH is similar to vaginal hysterectomy.
Robotic Assisted Vaginal Hysterectomy (RAVH):
Dr. Purdy routinely performs the da Vinci Hysterectomy, one of the most effective, least invasive treatment options for a range of uterine conditions. da Vinci Hysterectomy is performed using the da Vinci™ Surgical System, which enables Dr. Purdy to perform with unmatched precision and control – using only a few small incisions. da Vinci Hysterectomy also allows Dr. Purdy a better visualization of pelvic anatomy, which is especially critical when working around delicate and confined structures like the bladder and ureters. This means that Dr. Purdy has a distinct advantage when performing a complex hysterectomy involving adhesions from prior pelvic surgery or non-localized cancer..
The risk of problems related to hysterectomy is among the lowest for any major surgery. Dr. Purdy's risks are below the natural average for robotic surgeons.
He is a proctor who teaches this type of surgery to physicians for Intuitive Surgical, Inc.
Dr. Purdy will interview and obtain a past medical history and complete a physical exam a day or a few days before the surgery in order to accurately access the the patient's health. If a consultation is needed, there will be more time alotted. It is very helpful to know what to expect before any major surgery.
What to Expect for robotic hysterectomy surgery and laparoscopic assisted vaginal hysterectomy:
Dr. Purdy will usually see the patient back for evaluation:
Dr Purdy helps the patient plan for her return to normal activities. As she recovers, she may slowly increase activities such as driving, sports, and light physical work. If the patient can do an activity without pain and fatigue, it should be okay. If an activity causes pain, the patient must call and discuss the situation causing pain with Dr. Purdy.
Even after your recovery, you should continue to see Dr. Purdy for routine gynecologic exams. Dr. Purdy recommends thin Pap tests routinely of the vaginal every two years after a hysterectomy. If certain cancers were treated (eg cervical or endometrial cancer), then Dr. Purdy may recommend annual thin prep Pap smears of the vaginal cuff.
The vaginal cuff (apex) can still be infected with Human Papilloma Virus (HPV) that may induce abnormal cell changes that can develop into vaginal cuff atypia, vaginal dysplasia or rarely vaginal cuff cancer. High risk sexual activity can place the female's vaginal cuff at cancer risk. Smoking increases the risk of cancer of the vaginal cuff.