Comparison: Laparoscopic Retroperitoneal 2 Port Hysterectomy vs. Open Hysterectomy
In nearly all cases, open hysterectomies can now be considered a thing of the past. Women can avoid having painful, open surgeries for nearly all conditions that may require a hysterectomy. Whether you are suffering from fibroids; painful, heavy, or irregular periods; or even gynecologic cancer, nearly all women can have a minimally invasive hysterectomy instead of open surgery using Advanced Laparoscopic techniques. The Women's Surgery Center is the only medical practice in the United States that uses this method to approach all of our cases. The benefits of Advanced Laparoscopic Surgery can be seen below.
Laparoscopic Modified Radical 2 Port Hysterectomy vs. Open Modified Radical Hysterectomy
| 2 Port | Open | |
| Discharge Home | Less than 24 hours | 3 to 5 days |
| Recovery Time | 5 to 7 days |
6 – 8 weeks |
| Incision Size | Two 5mm incisions, one quarter inch | 8 to 10 inches, horizontal |
| Pain Tolerance | Excellent to good, mild to mod pain first 2 days | Fair to poor secondary to large hoirizontal incision |
| Complications | Minimal secondary to small incisions, minimal pain, rapid discharge from hospital, immediately ambulatory. Minimal adhesion formation decreasing pain and complications. |
Incision: Increased incidence of adhesion formation with possible ileus and bowel obstruction, increased incidence of stroke. Ambulation: difficulty ambulating with increased incidence of clot in legs and lungs due to venous stasis. Other: Increased incidence of radiation injury to small bowel due to adhesion formation, increased incidence of stroke and MI due to venous stasis and stress/pain, lung collapse and pneumonia, increased risk of hospital acquired infection (MRSA) secondary to prolonged hospital stay. Higher percentage of patients will require bladder Pcatheter placement for urinary retention secondary to the procedure. |
| Procedure Time | 30 to 60 minutes |
2 to 3 hours |
So why don’t all patients undergo advanced laparoscopic surgery instead of open procedures?
Very few gynecologic surgeons have received the proper training and exposure to perform advanced laparoscopic surgery successfully. The key to advanced laparoscopy is application of a technique called “retroperitoneal dissection,” or RP for short. RP refers to evaluation of the retroperitoneal space – the space underneath the lining of the body – which contains the blood vessels, lymph nodes, and ureter. Dissection of this space allows the surgeon to identify these structures and clamp specific arteries and veins as needed so the surgery can be performed successfully and with minimal blood loss. RP also allows isolation of the ureter – the tube that connects the kidney to the bladder for the flow of urine. The ureter is very close to the vessels, the ovaries, and the uterus, and is often involved with endometriosis, large fibroids and masses, and with malignancy. The ability to identify and isolate the ureter allows many procedures that could only be performed open to now be done safely with laparoscopy. Lymph node dissections can also be performed with dissection of the RP space, thereby allowing patients with cancer to be treated with laparoscopy. Since advanced training in pelvic surgery is usually needed to enter the retroperitoneal space safely, very few gynecologists have mastered this technique. Even fewer have applied these techniques laparoscopically. This is the reason advanced laparoscopic surgery is not offered as an alternative to patients.
By far, surgeon preference for open procedures is the main reason advanced laparoscopy is not more widely practiced. Open procedures take less time and are easier to perform. Advanced laparoscopic techniques are much more difficult to learn, and are not practiced by most gynecologists during their training programs. It is also important to understand that most OB/GYN’s practice obstetrics 80% of the time, with the remaining 15% of their time devoted to office gynecology, and only 5% to surgery. OB/GYN’s simply do not have the time or volume to learn advanced laparoscopic surgery. As a result, most GYN surgeons have very little exposure to dissection of the retroperitoneal space, and are not comfortable applying these techniques in surgery. Realize that surgeons are like everyone else – they are not comfortable doing something they are unfamiliar with – and many have a bias against laparoscopic procedures for this reason. As a patient, you need to ensure that your physician discusses with you all the options available, including laparoscopic surgery and the potential need for retroperitoneal dissection. If you feel you have not obtained all the facts from your physician, always consider a second opinion. Seek the advice of a well trained laparoscopic surgeon, such as an advanced laparoscopic surgeon trained in ALS techniques. It is also important to understand that a large number of procedures scheduled as laparoscopy are not completed that way, with the surgeon performing the procedure open after an "attempt" was made laparoscopically. As important as the surgeon’s experience is his or her success rate at completion of the procedure laparoscopically. Conversion of a laparoscopic procedure to an open one requires more time and leaves the patient with all the disadvantages of open surgery, including increased pain, hospital stay, blood loss, and far greater recovery time.
To review your medical condition with the surgeons at the Women's Surgery Center, complete the form on the left side of this page, or call us at 1-888-SURGERY.