New Hysterectomy Technique Means Quick Relief

January 19, 1992|By Anne Haddad | Anne Haddad,Staff writer

WESTMINSTER — The pain and bleeding was so bad the last year that she would have had a hysterectomy even if it meant the standard two months of recovery.

But three weeks after her doctor removed her uterus using a special instrument, Joan Stickles feels ready to return to her job tomorrow. The three tiny surgical incisions required no more than one staple each and a few Band-Aids the next day, she said.

"If I'd had a regular hysterectomy, I'd be laid up six to eight weeks," Stickles said. "I'm ecstatic about it."

Stickles, 35, of Gamber, is the first patient in Carroll County General Hospital -- and perhaps the country -- to benefit from a new technique for hysterectomies, said her gynecologist, Dr. Samuel Ahn.

Ahn and colleague Dr.Paul Vietz have worked with a German pioneer in developing a technique and instrument that allows the removal of the uterus without a large incision and preserves the outer wall and supporting tissue aroundthe cervix.

The technique is based on the philosophy of using theleast invasive surgery and preserving as much healthy tissue as possible, Vietz said. It can be used for most hysterectomies, as long as there is no cancer or large tumor, he said.

The procedure does notrequire the 4-inch incision through the abdominal wall that characterizes two-thirds of the 600,000 hysterectomies nationwide each year, Ahn said.

Other doctors and hospitals recently have begun doing more hysterectomies using a laparoscope -- the part of the technique that avoids the large incision -- but Ahn and Vietz said they have improved the method by also preserving part of the cervix and avoiding a vaginal incision.

He and Vietz said they met with Dr. Kurt Semm ofKiel, Germany, in August to develop the new technique and they are the only doctors in the United States using it.

Semm, with whom they had trained in 1987, returned to his workshop in Kiel and designed the instrument for the portion of the surgery that preserves the cervix.

The instrument, a long, thin metal tube, arrived just in time for Stickles' surgery Dec. 26.

Standard medical practice is to remove the cervix along with the uterus during a hysterectomy, even if the cervix is not diseased, Vietz said. Leaving the cervix in means the woman still has about a 2 percent risk of developing cancer there later, he said.

Vietz said the new technique removes the core of the cervix -- the part most susceptible to cancer.

The cervix plays a role in sexual pleasure, and the surrounding tissue supports the pelvic floor and reduces the chance of bladder problems later, Vietz said.

Ahn and Vietz call the technique CASH, for classic abdominal Semm hysterectomy. With the women under general anesthesia, three puncture-like incisions are made at the navel and the pubic hair line.

Surgeons insert a laparoscope, a thin tube with a camera on the end that transmits to a monitor. The other puncture incisions are for other instruments.

The Semm tube is inserted through the vagina to remove the core of the cervix and uterus. The uterus is removed througha thin instrument that cuts and pulls it out through a tube insertedin one of the punctures.

Ahn said the usual reasons for performing a hysterectomy are pain or bleeding from endometriosis, fibroids, or pelvic inflammatory disease.

Stickles suffered from endometriosis, in which the tissue that lines the uterus also is found elsewhere in the abdominal area, causing cramps almost every day for her.

She said Ahn recommended the hysterectomy after other surgery gave her no relief. Another local gynecologist also recommended surgery, but would have used a large incision, she said.

Laparoscopic hysterectomies are very new and may come with their own risks, said Dr. George W. Morley of University of Michigan at Ann Arbor, a national expert on hysterectomies and past president of the American College of Obstetrics and Gynecology.

While the laparoscope may yield shorter recovery time, it could result in damage to organs and tissue near the uterus, he said.

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