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Uterus removal technique speeds recovery by Heather Woolwine Public Relations Thanks to a procedure dubbed the laparoscopic supracervical hysterectomy (LSH), a woman who must undergo a removal of her uterus can now recover faster, easier, and without many of the scarring issues compared to more traditional ways of removal.   Although not an entirely new procedure, MUSC’s David Soper, M.D., professor and vice chairman for clinical affairs in the Obstetrics-Gynecology division of the Department of Medicine, and James Carter, M.D., OB/GYN associate professor, are able to use the procedure on difficult cases as well as more routine procedures.   “Our ability to perform LSH keeps our gynecology surgery program on the cutting edge,” Soper said. “By working together on the more challenging cases, Dr. Carter and I are able to offer this option to patients who might not otherwise be considered candidates for LSH.”   Traditional hysterectomies require a surgeon to perform the procedure through a large vertical incision in the abdomen about six inches in length, and patients experience moderate pain or soreness with the healing process. Recovery takes about six to eight weeks.   The new procedure however, is conducted solely through four tubes inserted into the abdomen at the sides and just below or in the navel, thus resulting in four smaller incisions that drastically reduce the amount of visible scarring. In addition, none of the procedure is conducted through the vagina, so the cervix remains intact and the chance of infection is reduced.   But the most noticeable difference attributed to this procedure is the drop in recovery time from six to two weeks. “It is not unlikely that patients are up and moving around, doing small chores or tasks within just a few days of the surgery,” Soper said. “The procedure itself might take a little longer than the traditional hysterectomy but the patient suffers much less due to faster healing from the smaller incisions.”   During the procedure, the uterus is removed through a morcellator, an instrument inserted through the 10 millimeter incision beneath the navel that cuts the solid uterus and removes it in strips. In general, the procedure takes about two to three hours to complete, depending on the size of the uterus. Larger or obese patients can sometimes require additional time.   A patient of Soper’s who recently underwent the laparoscopic procedure described herself as feeling great with no pain or muscle spasming one day after her operation. With eyes alert and an easy smile, it would be difficult for almost anyone to notice that she’d just undergone hysterectomy.   “Modern gynecology has embraced the minimally invasive approach to hysterectomy. LSH is just one more option for women needing removal of the uterus. When you add the benefits of a shorter or no hospital stay, a lower risk of infection and less time out of work, it’s easy to understand our enthusiasm for performing most abdominal hysterectomies laparoscopically,” Soper said. “As educators, we remain committed to teaching our residents these advanced laparoscopic skills. In doing so, more and more women will be able to avail themselves of these new minimally invasive approaches to the treatment of gynecologic disease.”   To better accommodate those challenging cases, like women with a very large uterus or body mass index greater than 35, Soper said that he and Carter are constantly discussing ways to improve the techniques and instrumentation associated with LSH.   Once the procedure is finished, most patients leave the hospital after a 24-hour stay while some patients can receive the procedure on an outpatient basis because there are no risk factors or other problems that might complicate a recovery.   The procedure is not limited to any particular age range, but those with moderate to severe cervical dysplasia are not candidates for the new procedure.     Friday, Aug. 5, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.