However, last week The Journal of the American Medical Association reported some surprising news that outlined some potential benefits of using estrogen-only therapy, which has been an option for the one-third of American women over the age of 50 who have had a hysterectomy (surgical removal of the uterus).

According to The Journal, a major government study found that women who had undergone hysterectomies followed by estrogen-only therapy were at a 23% lower risk of breast cancer compared with those who had taken a placebo. In comparison, the study confirmed that women who had taken combination estrogen-progestin hormone therapy were more likely to experience breast cancer.

These findings are based on extensive research as part of the Women’s Health Initiative (WHI) study, which was launched by the National Institutes of Health in 1991 to investigate hormone use and other health issues of postmenopausal women. More than 10,000 women who had previously had a hysterectomy participated in the study. Most took combination estrogen/progestin hormone therapy, but smaller groups of women took estrogen alone or a placebo.

While nobody is suggesting that women should take estrogen to prevent breast cancer, the WHI news could spur new medical research and help reassure millions of middle-aged women without a uterus who take estrogen to relieve menopause symptoms such as hot flashes.

In addition, women who were in their 50s when they first started using estrogen also experienced significantly fewer heart risks, including almost 50 percent fewer heart attacks relative to the women who took a placebo. For women over the age of 70, however, the estrogen-only group was more likely than the placebo group to experience heart trouble.

From my perspective, this report shows that estrogen therapy risks aren’t a simple issue, and that the potential risks and benefits of menopause hormones can be affected by a woman’s age, physical condition and the type of hormone used. If you’d like additional information, please feel free to contact my office directly.

Dr. John Garofalo, M.D., is gynecologist located in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

This combination of detail and precision makes da Vinci very well suited for a variety of surgery types and procedures, including several that I do regularly as part of my medical practice. For this blog I thought I’d talk about da Vinci surgery and hysterectomy.

Not your mother’s hysterectomy

If your mother or grandmother had a hysterectomy, it was probably done vaginally or through a horizontal incision in the abdomen. She probably stayed in the hospital for about six days, with a recovery period that lasted four weeks or longer. In comparison, women who have a da Vinci hysterectomy can expect to stay in the hospital for about one day, followed by about a week of recovery.

As a minimally invasive procedure, the da Vinci hysterectomy is a much simpler and less traumatic experience. Instead of a long incision, da Vinci hysterectomy uses five small incisions, spaced across the abdomen. Compared to open abdominal surgery, there’s less bleeding, less pain, minimal scarring, quicker recovery, a shorter hospital stay, and a lower likelihood of complications.

Here are a few quotes from women who have had da Vinci hysterectomies, including one of my own patients. These quotes and many others can be found on www.davincistories.com.

“I am truly amazed how quickly I was able to recover after having major surgery. My incisions were minimal, my recovery was quick.” – Maureen, Madison CT

“The da Vinci procedure has transformed the surgical procedure from a long, difficult recovery to a relatively painless, quick procedure with very little downtime. It is perfect for active working people who don’t have six weeks to be down.” – Anne, Enfield CT

“I had my surgery a week before Christmas, and I was up to entertaining for the holidays.” – Tina, West Suffield CT

More information

If you’d like more information or to see a da Vinci hysterectomy testimonial, go to this page on my website. The testimonial video is at the bottom:

http://www.garofaloobgyn.com/hysterectomy.html

If you need additional information, you can click on any of the links below, or you can contact my office directly. In my next blog, I’ll write about another condition called myomectomy that can also be treated using da Vinci.

Links to da Vinci surgery resources

daVinciSurgery.com

da Vinci Hysterectomy

da Vinci Surgery Patient Stories

Dr. Garofalo’s da Vinci information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon and gynecologist in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

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Hysterectomy, or surgical removal of the uterus, can be performed in different ways, including open surgery, laparoscopically, and vaginally. Open surgery provides the most effective way to ensure complete removal of the reproductive system but requires a wide incision through the abdominal wall. Laparoscopic hysterectomy is a minimally invasive procedure that uses thin, fiber-optic telescopes passed through into the abdomen through small cuts in the abdominal wall. In a vaginal hysterectomy, the surgeon operates entirely through the vagina.

While many tests have compared the safety and effectiveness of open and laparoscopic hysterectomies in recent years, relatively few have compared vaginal and laparoscopic hysterectomies. Many tests comparing vaginal and laparoscopic hysterectomies have concluded that vaginal hysterectomies are superior to laparoscopic hysterectomies.

Between April 2004 and April 2006, a team of physicians in Milan, Italy conducted a study to compare the two types of procedures. Sixty women participated in the study, with 30 having a laparoscopic hysterectomy and the other 30 undergoing a vaginal hysterectomy. Women with various medical complications or conditions that might have interfered with the study’s results were excluded. The results were published in the April 2009 American Journal of Obstetrics & Gynecology.

The study found that while the laparoscopic procedure took more time on average, the women who had a laparoscopic hysterectomy generally experienced less blood loss and a shorter hospital stay compared with the women who had a vaginal hysterectomy.

Average Comparisons

Laparoscopic                                         Vaginal

Average blood loss                                83.9 ml                                                178.2 ml

Average hospital stay                           2.7 days                                                3.2 days

Average length of operation               99 minutes                                          82 minutes

Candiani. Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol 2009.

Following the procedure, the women who had a laparoscopic hysterectomy generally reported a lower average level of pain on the day of the surgery and experienced faster recovery from pain in the days that followed. The average number of days before returning to work was not significantly different between the two groups.

The women came in for check-ups one, six and 12 months after their procedures. They were evaluated in terms of pelvic pain, urinary dysfunctions, sexual activity, vaginal infections and other factors. Based on clinical and ultrasound evaluations, the two procedures were equally effective.

http://www.garofaloobgyn.com/hysterectomy

http://es.garofaloobgyn.com/hysterectomy.html

Candiani M, Izzo S, Bulfoni A, et al. Laparoscopic vs vaginal hysterectomy for benign pathology. Am J Obstet Gynecol 2009;200:368.e1-368.e7