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Uterine artery embolization is a relatively non-invasive procedure to stop the blood supply to the existing uterine fibroids in order to eliminate them. It involves a catheter through the artery and lasts for about an hour, but after the procedure, the uterus is intact. The fibroids do not have blood to feed them, so they disappear. But is it really a better solution than the hysterectomy, given that the symptomatic uterine fibroids may return within a year or two, and that with hysterectomy they cannot return because the uterus isn’t there any more?

Here’s a comparative study, with the full name of

Uterine artery embolisation or hysterectomy for the treatment of symptomatic uterine fibroids: a cost-utility analysis of the HOPEFUL study

by Wu, O. and Briggs, A.H. and Dutton, S. and Hirst, A. and Maresh, M. and Nicholson, A. and McPherson, K. (2007), and published in BJOG: An International Journal of Obstetrics and Gynaecology 114(11):pp. 1352-1362.

They wanted to see which procedure should be favourized from the standpoint of UK NHS. There were 649 women who underwent UAE (Uterine Artery Embolisation) and were followed for the 8.6 years in average, while there were 459 women with hysterectomy, which were followed for up to 4.6 in average.

Two main measures were the Costs of procedures and complications, and Quality Adjusted Life Years (QALY) UAE had the lower cost, £2536 versus £3282, small reduction in quality of life (8.203 versus 8.241 QALYs) when compared with hysterectomy. However, when the quality of life associated with the conservation of the uterus was incorporated in the model, UAE was shown to be the dominant strategy—lower costs and greater QALYs.

The result of the study is that simply more women should be allowed to UAE instead of going directly to hysterectomy. This is especially important if the woman wants to preserve her uterus.

The abstract of the Uterine Artery Embolisation or Hysterectomy For the Treatment of Symptomatic Uterine Fibroids study is published by the University of Glasgow.

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Here is a recent case in India — I’ll quote from the blog post from the Law and Other Things blog

“…the doctor began by conducting a diagnostic laparoscopy but followed it up immediately thereafter, having obtained additional consent only from the patient’s mother (as the patient was still unconscious), with a second and more elaborate treatment procedure (‘laparotomy’) that resulted in removal of the patient’s uterus and ovaries (hysterectomy and bilateral salpingo-oophorectomy). [The patient, upset over this fact, refused to pay upon discharge. The doctor sued for recovery of charges and got a favorable ruling from the National Consumers' Commission. The patient appealed in the SC]. The consent form signed by the patient at the very beginning stated that the patient had been informed that the treatment to be undertaken is ‘diagnostic and therapeutic laparoscopy. Laparotomy may be needed’. The outcome of the case turned on the definition of ‘laparotomy’ – the word simply refers to opening the abdomen; so, in this instance, did it also imply consent to remove organs from the patient’s abdomen after it had been opened (as the doctor argued)? The court’s answer was in the negative and it emphasized that if that was indeed the case, the consent form ought to have read “”diagnostic and operative laparoscopy. Laparotomy, hysterectomy and bilateral salpingo-oopherectomy, if needed.”

It is a real life situation that has plagued many women who wanted their gynecological problems solved, and instead, ended up without their reproductive organs to the end of their days.

It really is in the discretion of the surgeon. The patient is unconscious, and may not be able to undergo another major surgery if the surgeon woke her up just in order to ask her whether she would like to have the foci of cancer, for example, preserved…

Now let’s reverse the situation. The consent only gave permission for some surgery and not for any radical surgery at all and let’s suppose that the surgeon visually found out the masses of cancerous tissue all over the uterus and abdomen? Wouldn’t he be neglecting his duty to cure if he just dully noticed that the patient is soon going to die but what the heck, there is no written consent, so let her wake up and then tell her the situation. Would she still be suing him for not operating properly on her?

The moral of the story is — you never know what will happen. And that is why I am always advocating avoiding hysterectomy if possible, not going for it like it’s a picnic… because it is not!

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When you read forums and somebody says they are heading for hysterectomy, almost always one or two participants stands up saying that hysterectomy was the best thing that ever happened to them in their lives! OK, maybe that’s how it was for them, but not everybody has their own little “happy hysterectomy”. The case in point is Christine from Atlanta, let’s quote from this article:

Exactly one week after the hysterectomy, Christine awoke in horrible pain and immediately went to her doctor’s office. When she passed out in his waiting room, an ambulance took her to a hospital.

A CT scan revealed urine was accumulating in her abdomen. Christine says her doctor explained what he thought went wrong: When he was using a cauterizing tool, he must have nicked the ureter, the duct that carries urine from the kidneys to the bladder. “He really owned up to it,” Christine says.

The next day, her doctor implanted a nephrostomy tube, so Christine’s urine could accumulate in a bag outside her body. A week later, she had a third procedure to insert an internal stent to replace the tube and the bag. When that stent caused her pain, doctors removed it in a fourth surgery. Today, Christine is scheduled to have a fifth procedure to fix her ureter, which has become almost completely blocked by scar tissue.

Grant says the complication that caused all these problems — the nicking of a ureter — would most likely be considered a regular complication of the surgery, and not negligence. This means that even though Christine has clearly suffered, she wouldn’t have a case. “Just because you have a bad outcome doesn’t mean you can sue,” he says.

Since she lives in the USA, her relatives wanted her to sue, but it doesn’t seems it is possible — her costs are too small for an attorney to have a profit at court. (That’s what happens when you live in a profit driven justice system.) She is not well, and the money is gone. Being a physician herself, she knows how major surgeris can be dangerous…

Bottom line: avoid hysterectomy if you can.

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The Da Vinci Robot controlled hysterectomy is one step beyond traditional laparoscopy. One of the main problems with open surgeries were incisions, which meant more pain, scarring, loss of blood, longer hospital stays, increased risk of infections, slower recovery and slower return to normal life. Laparoscopy turns that around, but robotic surgery ups the ante even more.

Here is how it is summarized in article Baptist Hospital now offers robot-assisted hysterectomies:

Traditional open-incision hysterectomies generally require 5-to-12-inch incisions, 3-to-4 days of hospitalization and 6-to-8 weeks off work. Dr. Thomas-Doyle reserves those surgeries for more complicated cases. She has long preferred using less-invasive laparoscopic techniques for her hysterectomy patients. With laparoscopy the large open incision is replaced by a handful of button-size cuts — or ports — through which instruments, including a viewing camera, are inserted and manipulated. Patients remain in the hospital for 24 hours and can return to normal activities in about three weeks.

The da Vinci system takes laparoscopy to the next level: robotic surgery. Visualization is greatly improved with da Vinci robotics. With traditional laparoscopy, the surgeon’s movements must be performed in “mirror image” of what she is doing. The three-dimensional, high-definition da Vinci camera corrects this electronically, allowing a more natural view for the surgeon. The viewing field also can be magnified up to 12 times actual size.

Additionally, da Vinci robotics provides surgeons with an incredible degree of precision. The system bypasses human limitations by correcting unintentional tremor and allowing greater flexibility. While both traditional laparoscopy and robotic surgery result in less discomfort and quicker recovery, the exquisite precision provided by the da Vinci system allows more complex cases to be performed less invasively.

Of course, we at this site, want women to avoid hysterectomy in the first place, however, if it must come to that, the da Vinci robotic surgery may be the way to go, if available to you. Here is the link at youTube.com where you can see the procedure in its entirety:

http://www.youtube.com/watch?v=S4jX6_Fq6VU

It is over 1 hour long. (Clicking on that link will open a new window, embedding this particular video is forbidden upon request.)

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