Quad Cities, IL/IA

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Weekend Hysterectomy


Submitted by Diamond Medical Spa and Vein

It was the year 1988, Dr. Yates was in his third year of OB/GYN when he chose to perform a vaginal hysterectomy on a woman that appeared to be a candidate for a vaginal hysterectomy. In those days there were only two methods to perform a hysterectomy. The main method was to perform a vertical midline or a Pfannenstiel (Bikini-cut) abdominal incision.

Even then, most GYN surgeons were making vertical midline incisions. The abdominal incisions caused more bleeding and post op complications from patients lying in bed  5-6 days post operatively due to pain. In fact, the worst thing a patient can do is stay in bed especially after pelvic surgery. The older, impatient surgeons preferred the abdominal approach to hysterectomy.

Dr. Yates was young and liked the advantages of vaginal hysterectomy. Such as, patients recovered twice as fast and were out of the hospital usually in 2 days. With vaginal hysterectomy they had less bowel ileus, nausea, felt better sooner and the older doctors did not like to do them because it was more technically demanding.

When he got to surgery everything was proceeding fine until it was time to take the uterus out. It would not come out vaginally no matter what he and his chief resident tried! What was he we to do? They had to finish the surgery and in those days the only choice was to convert the surgery to the ‘old fashioned’ abdominal hysterectomy. To Dr. Yates this felt like going and putting on your great granddaddy’s underwear. Not cool.

So he said to his chief resident, “Why don’t we just put a laparoscope into the abdomen and see what is preventing the uterus from coming out?! It could be a little tiny strand of adhesion (scar tissue).” The chief was angry and upset and said, “No, we are not going to invent a new surgery today…we’re in enough trouble to explain why we had to convert this vaginal case to an abdominal case.” So they changed all of the instruments and made a ‘Bikini-cut ‘ incision and found… teeny, weeny, truncated (short), strands of round ligament suspending the otherwise detached uterus. It was just dangling there. Dr. Yates was extremely irritated that they had not put in a laparoscope instead of opening the patient’s abdomen.

They did not have the internet back then. They had these things called ‘Libraries’ with ‘journals’ you had to read and search through for meaningful innovations. The journals were made out of paper. Dr. Yates did not know that Laparoscope Assisted Vaginal hysterectomy had already been invented in Germany in 1984. News traveled much slower in those days. What he also did not know was that it was not until 1988 that Dr. Reich first performed the procedure in Pennsylvania. Dr. Yates and his chief could have been among  the first surgeons to perform LAVH in America. Haunted by this fact, he was determined to be the first to perform LAVH in the Quad Cities.

There are many techniques for performing hysterectomies. Ninety percent of hysterectomies are done for non-cancer (benign) indications. Surgical “indication” relates to the actual reason for a specific procedure. The benign indications for hysterectomy may be excess uterine bleeding, not responding to medication, or minimally invasive procedures, such as endometrial ablation or hormonal therapy. Other indications may be endometriosis, chronic pelvic pain, symptomatic uterine fibroids, and pelvic adhesions. The type of hysterectomy approach a physician chooses is dependent upon the surgical skill level of the individual doctor and the specific reason for the surgery.

Total Abdominal Hysterectomy (TAH) is the most common method. Total Vaginal Hysterectomy (TVH) is second. Laparoscope Assisted Vaginal Hysterectomy (LAVH) is third. Laparoscopic Supracervical Hysterectomy (LSCH) and Total Laparoscopic Hysterectomy (TLH) are technically more demanding and fewer gynecologists have the requisite skill to perform them. For laparoscopic surgeries, even a robot can be placed between the surgeon and the patient to help perform the procedure. The major distinctions between the surgical approaches as far as patients may be concerned is whether the abdomen or vagina is opened, if mini incisions are used to access the uterus, and if the cervix remains or is removed with the uterus.

The words “total” or “vaginal” when describing hysterectomy procedures indicate the uterus and cervix are removed. When lay people refer to a hysterectomy as “partial,” most people aren’t often sure what they mean. Are they referring to the uterus only, the uterus and cervix being taken out, or the uterus, cervix, tubes and ovaries? When both tubes and ovaries are removed the term “Bilateral Salpingoophorectomy” (BSO) is added to the surgical description. For instance, Total Abdominal Hysterectomy Bilateral Salpingoophorectomy (TAHBSO) indicates that the entire internal female genital tract except the vagina is removed.

By the mid 1990s it was becoming apparent that cervical cancer was declining. Dr. Yates reasoned that for women with low risk of cervical cancer, perhaps leaving the cervix in would be of benefit. While practicing in Florida, he became aware of a great controversy about whether to remove the cervix or not with hysterectomy. Several high-profile law suits against other gynecologists were generated when patients had not been told that they might experience decreased sensation during intimacy or lose the ability to have an orgasm, have lower libido, and other sexual dysfunction with removal of the cervix during hysterectomy. However, large studies have shown that sexual satisfaction improves after hysterectomy for a number of reasons.

What Dr. Yates discovered was that this approach led to hysterectomy being a same-day, outpatient procedure. The surgery is essentially bloodless, and the recovery so fast that many working patients would have surgery on Thursday or Friday and return to work by Monday. He obtained a copyright and named this technique “weekend hysterectomy.” Still, the operating times were too long due to having to operate using surgical instruments originally developed by surgeons for other non-hysterectomy procedures. Frustrated with the common surgical instruments Dr. Yates engineered the “QuickHyst” device for “Weekend Hysterectomy”.

“Weekend Hysterectomy” is only indicated in benign, non-cancer hysterectomy procedures because the uterus is removed through a small tube. Extracting the uterus in this fashion (morcellation) requires a device that will cut the uterine tissue small enough to be removed through the small tube. Prior to having a “Weekend Hysterectomy” an evaluation is performed to insure that there is no cancer of the cervix or uterus. A recent Pap smear should be available. A recent pelvic ultrasound should be performed. A recent endometrial biopsy or dilation curettage (D&C) pathology report should be available. There are other criteria to consider who is an appropriate candidate for Laparoscopic Supracervical “Weekend Hysterectomy”.

There is no easier way to recover from a hysterectomy than “Weekend Hysterectomy.” While it is not new, there are not many physicians able to offer this technique. Dr. Yates has the most experience with this and is the only gynecologic surgeon performing Laparoscopic Supracervical Hysterectomy in the region. For over 20 years, the “Weekend Hysterectomy” has been the choice of over 99 percent of Dr. Yates’ patients. Diamond Medical Spa and Vein has state-of-the-art answers for your cosmetic and healthcare needs. For more information call 563 275-4701. They are amongst the leaders in the field with “minimally invasive, maximum results!”

Diamond Medical Spa & Vein is located at 3170 E. 53rd Street in Davenport. Call 563-275-4701 today to schedule a consultation.

Photo credit: svetikd/iStock

Weekend Hysterectomy

The device received patents in the U.S., Canada, Europe, Japan, and Australia. Theoretically, “QuickHyst” will allow gynecologists to perform outpatient, benign hysterectomies in less than 30 minutes, rather than taking several hours. Until the “QuickHyst” instrument is commercially available, the “Weekend Hysterectomy” technique provides:

  1. The least amount of blood loss
  2. The least painful recovery of any hysterectomy method
  3. The fastest healing and return to work
  4. The smallest, fewest, best-healing cosmetic incisions
  5. The safest hysterectomy method
  6. The most cost-effective hysterectomy method
  7. The fewest complications of any hysterectomy method
  8. No ureteral, bladder, or bowel injuries
  9. The cervix is not removed to maintain nerve connections that may be desirable for sexual satisfaction
  10. Lowest infection rate of all types of hysterectomy