Simply put, a hysterectomy is a surgery to remove your uterus. The uterus is the medical name for your womb: the place where a fetus develops when you’re pregnant.
When done laparoscopically, your surgeon simply makes two or three tiny incisions to perform the surgery, avoiding not just unsightly scars but a lot of healing time and pain. Outpatient surgery is done without the need for any hospital stay and you go home the same day.
Hysterectomies are the second most commonly performed surgery on American women after cesarean deliveries. There are almost half a million hysterectomies performed each year in the United States; 80% of those are for treatment of benign diseases, such as leiomyoma, abnormal uterine bleeding, pelvic organ prolapse, and endometriosis.
Why would a woman need an elective hysterectomy?
A gynecologist might recommend an elective hysterectomy for medical conditions, such as:
Uterine fibroids that cause pain or excessive vaginal bleeding
Endometriosis treatment
Uterine prolapse (when the uterus slips from its normal position into the vaginal canal)
Uterine, cervical or ovarian cancer
Chronic pelvic pain
Abnormal uterine bleeding between menstrual periods that has not responded to medical treatment
Abnormal thickening of the uterus (called adenomyosis)
Sometimes your doctor may recommend an additional surgical procedure to remove another pelvic organ with the hysterectomy, such as:
Removal of the ovaries (called an oophorectomy)
Removal of the fallopian tubes (salpingectomy)
Are all elective hysterectomy surgeries the same?
No! In fact, there are four ways to perform a hysterectomy and each surgery has its own limitations:
Open abdominal hysterectomy which is, sadly, how 80% of all hysterectomies are performed today. In this procedure, the uterus is removed in one piece through a seven-inch (or longer) incision in the lower abdomen. Open surgery involves at least three days in the hospital and a generally painful recovery lasting from weeks to months.
Unfortunately, this approach can give rise to complications such as significant blood loss, tissue damage, and infection.
Vaginal hysterectomy – During a vaginal hysterectomy, the surgeon makes an incision through the top of your vagina and, using special instruments, detaches your uterus from the ovaries, fallopian tubes, and upper vagina. The uterus is also disconnected from the blood vessels and connective tissue that support it, before being removed through your vagina.
The advantage of a vaginal hysterectomy over an abdominal approach is that it’s less invasive and requires less time to perform; which means less anesthesia, a shorter hospital stay and a quicker recovery. Unfortunately, this procedure is limited to women with average to smaller sized uteri, who do not have pelvic scar tissue from prior surgery (known as adhesions), and who also have no possibility of having cancer.
Laparoscopic-assisted vaginal hysterectomy involves the removal of the uterus through the vagina using visual guidance provided by a small camera known as a laparoscope that is inserted through small abdominal incisions. Again, because the uterus must exit through the vagina, this procedure may not be an option for patients with very large uteri, a lot of pelvic adhesions, or if there is any chance that cancer may be present.
Laparoscopic hysterectomy is a minimally invasive approach that allows the surgeon to make a few small incisions in your abdomen and, under the guidance of a laparoscope, remove the uterus in small pieces. If there’s a chance of cancer being present, our approach is still a 100% safe surgical option.
New advances perfected by our surgeons have solved that problem as we remove the uterus by breaking it into small pieces (a technique called morcellation) after the insertion of, in effect, a sterile bag. This completely isolates the organ so there is no chance of any cancer cells coming in contact with any other part of your abdomen.
What is a minimally invasive laparoscopic hysterectomy? How is it an improvement over traditional laparoscopic procedures?
This minimally invasive out-patient hysterectomy (MIOPH) that is being performed by Dr. Thais Aliabadi and Dr. Ramon Yera is a significant advancement of the traditional laparoscopic technique in two important ways.
It makes the hysterectomy procedure much safer than it previously was.
It also greatly increases the number of women who qualify for a laparoscopic hysterectomy.
We improve upon the traditional laparoscopic hysterectomy in three significant ways:
The minimally invasive technique solves the problem of residual uterine tissue being left behind after the uterus is divided into bits before its removal through the small surgical incisions. This is thanks to a new technique called in-bag morcellation. Specifically, a sterile bag is inserted through an umbilical incision to wrap the uterus and isolate it from the rest of the body before it is cut into pieces small enough for extraction through the tiny laparoscopic incision.
After the in-bag morcellation process is complete, the bag containing the uterine fragments is then sealed and taken out via the belly button incision. By containing the morcellation process, the sterile bag prevents possible dispersion of any tissue throughout the abdomen. This containment is critically important if there is any possibility that cancer cells might be present.
This breakthrough bag technique has made laparoscopic hysterectomies available for the first time to patients with uterine pre-cancerous cells, a malignant tumor, or a family history of uterine cancer.
The second improvement offered by the MIOPH approach is a reduction in the size and number of incisions needed. Our minimally invasive outpatient hysterectomy is performed through just two or three 5mm wide incisions (depending on the exact needs of the procedure); Fewer and smaller incisions mean less tissue disruption, less blood loss, and a quicker, less painful recovery.
In fact, our patients are up and about the day after their surgery and typically resume their normal routine within a week.
The final, and most important, advancement offered by the minimally invasive out-patient hysterectomy is that, for the first time, surgeons are able to remove a uterus or fibroids of any size safely through an incision just 5mm wide.
Recently, Dr. Aliabadi removed an eight-pound fibroid tumor the size of a watermelon on national television.
With our laparoscopic hysterectomy surgery, women benefit in many ways, including:
NO NEED TO PUT THEIR LIFE ON HOLD FOR WEEKS TO RECOVER Most of our patients return to normal activities in one week or less, versus 6 to 8 weeks needed for open hysterectomy recovery
A FASTER SURGERY Since a minimally invasive laparoscopy performed by our experienced surgeons are done faster than an open abdominal hysterectomy
LESS TIME UNDER GENERAL ANESTHESIA: Which makes your surgery much safer
GO HOME THE SAME DAY OF SURGERY: Apart from being more comfortable for most patients, recovering at home has a much lower infection risk versus staying in a germy hospital environment
MINIMAL BLOOD LOSS: Makes it safer for patients by avoiding risky transfusions
BARELY VISIBLE SCARS There are only THREE TINY INCISIONS made on the abdomen, each only 5mm wide
MUCH LESS PAIN When compared to open surgery because the abdominal wall is left mostly intact
LOWER RISK OF POST-OP BLOOD CLOTS: Because MIOPH is much less disruptive than open abdominal surgeries that can result in deep venous thrombosis or pulmonary embolism
With all of these advantages for the patient, no wonder most medical insurers readily authorize minimally invasive outpatient hysterectomies.
Our outpatient laparoscopic hysterectomy recovery and what to expect…
Below is a summary of key differences between the two types of hysterectomy:
Our Minimally Invasive Hysterectomy
Open Abdominal Hysterectomy
Duration of Surgery
1 Hour
1-2 Hour
Number/Size of Incisions
Three/ 5mm long
One/ 5 to 7 inches long
Length of Hospital Stay
None
3 days
Recovery Time
1 week
6 to 8 weeks
Why do so few surgeons perform outpatient laparoscopic hysterectomies?
In order for surgeons to perform minimally invasive out-patient hysterectomy safely, and with excellent outcomes, a high degree of training and a high volume of cases is needed to master the technique.1 Sadly, this is why so many surgeries that begin as laparoscopies must be converted into open hysterectomies when the surgeon comes up against a problem that they lack the skills to solve laparoscopically.2
This is why most surgical consents for a laparoscopic hysterectomy include a clause giving the surgeon the option to convert to an open abdominal hysterectomy if they feel it is necessary. The high conversion rate from laparoscopy to open surgery has given women desiring a minimally invasive approach a false choice when it comes to opting to undergo a laparoscopy. That is, until now.
TODAY, NEARLY EVERY WOMAN IS ELIGIBLE TO RECEIVE A MINIMALLY INVASIVE HYSTERECTOMY.
Welcome to the first minimally invasive outpatient surgical practice dedicated to women.
For years, Drs. Yera and Aliabadi have spared women from experiencing invasive open surgeries associated with disfiguring surgical scars, extended hospital stays, and long painful recoveries.
All of this unnecessary suffering was simply because women weren’t aware that minimally invasive outpatient surgery was available.
Luckily, the women of Southern California (and those who wish to travel here) now have a choice. Drs. Aliabadi and Yera are among a handful of elite American Ob/Gyn surgeons who perform Minimally Invasive Outpatient Hysterectomies.
After performing thousands of these procedures and teaching this surgical technique to gynecologists throughout the U.S. and abroad, Drs. Aliabadi and Yera collaborated to create an outpatient surgery practice exclusively for women. Their goal is to raise the bar for women’s health by making these procedures more widely available to women everywhere.
If you have been told that you need a hysterectomy, consider minimally-invasive outpatient surgery. Because your health and time are among your most important possessions.
If you wish to schedule a consultation to learn how we can help you or to establish care with us, please request a consultation online or call us at 844-541-7900.
Risk of venous thromboembolism in abdominal versus minimally invasive hysterectomy for benign conditions. Barber EL, Neubauer NL, Gossett DR https://www.ncbi.nlm.nih.gov/pubmed/25511239
Surgical volume and conversion rate in laparoscopic hysterectomy: does volume matter? A multicenter retrospective cohort study. JHM Keurentjes, JM Briet, GH deBock, MJE Mourits Am J Obstet Gynecol. 2015 May;212(5):609.e1-7. Doi:10-1016/j.ajog.2014.12.006. Epub 2014 Dec 12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772131/
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Frequently Asked Questions
How is post-surgical pain managed at home?
After a laparoscopic hysterectomy, post-surgical pain at home is typically managed with prescribed pain medications, rest, applying heat or cold packs to the abdomen, light activity to promote healing, staying hydrated, and following the doctor's post-operative care instructions diligently.
What anesthesia is used for day surgeries?
For day surgeries, anesthesia options may include general anesthesia, regional anesthesia, or local anesthesia, depending on the procedure and patient preference. Discuss the options with your healthcare provider to determine the most suitable choice for your surgery.
Will medical insurance cover day procedures?
Insurance typically covers outpatient hysterectomies. With our advanced laparoscopic technique, most insurers authorize the procedure due to its safety and benefits. Patients have minimal downtime, quicker recovery, and reduced risk of complications, making it a preferred option for many.
How quickly can normal activities resume post-surgery?
Most patients can resume normal activities within one week after minimally invasive outpatient hysterectomy, compared to 6-8 weeks with open surgery. The faster laparoscopic approach allows for a quicker recovery, less pain, and minimal scarring with barely visible incisions.
What pre-op tests are required for surgery?
Pre-operative tests required for surgery typically include blood work, a physical exam, and possibly imaging studies like X-rays or MRI scans. Additional tests may be needed based on the specific procedure and the patient's medical history. Consulting with the surgeon and following their instructions is crucial for preparing adequately for surgery.
Do day surgeries require overnight monitoring?
In most cases, day surgeries do not require overnight monitoring. Patients can typically go home the same day after undergoing a day surgery procedure, as long as they meet the necessary criteria for discharge and do not experience any complications post-surgery.
How are complications handled in day surgeries?
Complications in day surgeries are typically addressed by ensuring the surgical team is trained to handle any unexpected issues promptly and efficiently. Surgeons may have the option to convert to open surgery if needed. This proactive approach helps manage complications effectively in outpatient settings.
Are day surgeries less invasive than traditional?
Day surgeries, like laparoscopic hysterectomies, are less invasive than traditional approaches. Minimally invasive procedures offer advantages such as smaller incisions, shorter recovery times, and reduced risk of complications, making them a less invasive option for patients.
How long before driving is permissible post-surgery?
Driving after surgery is usually allowed once you are off pain medication, able to move comfortably, and have no restrictions from your surgeon. It is generally recommended to wait at least 1-2 weeks after outpatient laparoscopic hysterectomy before driving.
What are common post-surgery symptoms at home?
Common post-surgery symptoms at home include pain, discomfort, fatigue, and possible nausea. Patients may also experience changes in bowel movements, mild swelling or bruising, as well as emotional ups and downs. It's essential to follow post-operative care instructions and reach out to the medical team if concerns arise.
Are any age limits for elective day surgery?
There are no specific age limits set for elective day surgery procedures. The decision is typically based on the patient's overall health condition rather than their age. Consultation with a healthcare provider is essential to determine the suitability of day surgery based on individual health needs.
How soon can one shower after surgery?
After surgery, you should wait at least 24 hours before showering to allow the incision site to heal properly. Consult your surgeon for personalized advice on when it's safe for you to resume showering. Follow post-operative care instructions carefully for optimal recovery.
Are day surgeries more cost-effective overall?
Day surgeries are typically more cost-effective overall due to reduced hospital stays, lower anesthesia costs, and less post-operative care. Additionally, outpatient procedures often minimize the need for expensive hospital resources and decrease the risk of healthcare-associated infections, contributing to cost savings.
What diet restrictions follow day surgeries?
After day surgeries, it's essential to follow a light diet with clear liquids. Avoid heavy or greasy foods initially. Gradually reintroduce solid foods and hydrate adequately. Focus on foods that are easy to digest to aid in recovery.
Are day surgical scars significantly smaller?
Day surgical scars are minimal, with only three tiny incisions of about 5mm each. This small incision size leads to barely visible scars and less post-operative pain. The laparoscopic approach allows for quicker recovery, reduced blood loss, and lower risk of complications compared to traditional open surgery.
Can day surgeries have robotic assistance?
Robotic assistance can be utilized in day surgeries, offering enhanced precision and quicker recovery times. Robotic technology enables surgeons to perform complex procedures with minimal invasiveness, potentially making it suitable for some outpatient gynecological surgeries.
How are emergency situations handled post-surgery?
In the event of an emergency post-surgery, our experienced team is available around the clock to provide immediate assistance. Patients are instructed on how to contact us in case of any urgent situations, ensuring prompt and effective care.
What is the usual follow-up schedule after surgery?
After surgery, the typical follow-up schedule may involve a post-operative visit with the surgeon within 1-2 weeks to assess healing and address any concerns, followed by additional appointments at intervals determined by the individual's progress and any specific treatment requirements.
Can personal medical history disqualify from day surgery?
Yes, personal medical history can disqualify someone from day surgery depending on the specific condition, risk factors, or complications involved. It is essential for healthcare providers to assess each case individually to determine the suitability of day surgery based on a patient's medical background and current health status.
Are blood transfusions needed for day surgeries?
In minimally invasive outpatient hysterectomies, blood transfusions are usually not needed due to minimal blood loss during the procedure, which contributes to a safer recovery with lower risks of post-op blood clots, making it safer than traditional open abdominal surgeries.
How is blood loss minimized during day surgery?
During day surgery, blood loss is minimized through minimally invasive laparoscopy techniques. This approach involves making small incisions and using advanced tools to remove the uterus in pieces, reducing the risk of significant blood loss associated with traditional open surgeries.
Can day surgeries correct prolapse effectively?
Day surgeries like outpatient laparoscopic hysterectomy can effectively correct prolapse, providing a minimally invasive solution with faster recovery times, fewer complications, and minimal scarring, making it a beneficial option for patients seeking treatment for prolapse.
Are there restrictions on lifting after surgery?
Following outpatient laparoscopic hysterectomy, restrictions on lifting generally include avoiding heavy lifting for a few weeks. It's advised to gradually increase activity levels based on your recovery progress. Consult your surgeon for personalized guidance.
How soon can one exercise after surgery?
After surgery, patients can usually begin light exercises like walking within a few days, progressing to more intense workouts based on individual recovery and doctor's recommendations. It's important to gradually increase activity levels to avoid complications and promote healing.
Are family members allowed post-surgery care?
Visitors are allowed after the surgery, but preferably, family members wait in designated areas. Immediate post-op care is typically provided by the medical staff, ensuring patients are comfortable and safe. It's recommended to check with the medical facility for specific post-surgery care guidelines and visitor policies.
Can day surgery reduce hospital-acquired infections?
Day surgery can reduce hospital-acquired infections by allowing patients to recover at home, minimizing exposure to additional pathogens in hospital settings. This approach may lead to fewer infections, shorter hospital stays, and decreased risk of complications associated with extended hospitalization.
How soon to expect full recovery post-surgery?
Patients can typically expect a full recovery within one week post-surgery with a minimally invasive outpatient hysterectomy. This approach results in minimal pain, quicker return to normal activities, less time under general anesthesia, and a lower risk of post-op complications like blood clots.
How is bladder function affected post-surgery?
Post-surgery, patients may experience temporary bladder dysfunction due to swelling or trauma caused during the procedure. This can result in urinary urgency, frequency, or leakage, but typically resolves as the body heals. Close monitoring and follow-up with a healthcare provider are essential to address any persistent bladder issues.
Are sexual functions impacted post-surgery?
Sexual functions are not typically impacted post-outpatient laparoscopic hysterectomy. The minimally invasive approach reduces complications and promotes quicker recovery time, allowing patients to resume normal activities sooner without significant impact on sexual functions.
Can hormone levels fluctuate after surgery?
Yes, hormone levels can fluctuate after surgery due to various factors such as stress, anesthesia, and changes in the body's hormonal balance in response to the procedure. It's important to consult with your healthcare provider for guidance on managing post-operative hormonal changes.
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For years, Drs. Yera and Aliabadi have spared women from experiencing invasive open surgeries associated with disfiguring surgical scars, extended hospital stays, and long painful recoveries.
