Many women in their lifetime will need to have their uterus and cervix removed (total hysterectomy) for benign or malignant reasons. In previous years, the recovery from the operation was particularly arduous, with several days of hospitalization, intense pain, restriction of movements and delay in feeding. Fortunately, these days, the patient experience is significantly better!

What are the main indications for hysterectomy?

Some of the main reasons a woman may need a hysterectomy include:

• Uterine fibroids
• Idiopathic gynecological bleeding
• Endometriosis and adenomyosis
• Precancerous lesions and endometrial cancer
• Precancerous lesions and cervical cancer
• Uterine sarcomas
• Borderline tumors and ovarian cancer

How is total hysterectomy performed these days for benign causes or incipient endometrial cancer?

In the past, surgical removal of the uterus was an operation that required a large incision and several days of hospitalization. Nowadays, that has changed. With laparoscopic and robotic surgery, total hysterectomy is performed through very small incisions, 0.5-1cm in diameter, resulting in much less post-operative pain and faster recovery. Thus, the vast majority of women can be discharged from the hospital on the same dayor, depending on the age of the patients and the general health problems they may have, the day after the operation. In the same context and as long as the nature of the patients’ work allows it, the return to their professional duties can be done within a few days.

In addition to the type of surgery, how important are the physician’s perioperative instructions to the minimal hospitalization of patients after hysterectomy?

For many years, after any abdominal surgery, patients were slow to get out of bed and eat. Now we know that this not only did not help in most cases in their recovery, but significantly delayed it. Today, in the largest centers internationally, rapid postoperative recovery (ERAS) protocols are applied, with the aim of reducing the physical stress that accompanies surgery. These protocols are a network of instructions that succeed in properly preparing the patients’ body for the operation (e.g. administration of nutritional supplements up to a few hours before anesthesia), ensure the maximum possible analgesia and prevent post-operative nausea, infections and thrombosis. Scientific data show that the implementation of rapid postoperative recovery protocols leads to a reduction in complications and hospital stay, while increasing patient satisfaction with their perioperative care.

How safe is it to treat early endometrial cancer laparoscopically or robotically?

The largest studies that aimed to examine the safety of laparoscopic and robotic surgery in endometrial cancer demonstrated that patients do as well oncologically as in open surgery. At the same time, however, they found that laparoscopic and robotic surgery is associated with a significantly lower probability of complications, such as blood loss, thrombosis, inflammation or hernia in the surgical wound and leads to a faster recovery. For these reasons, both in Europe and in America, scientific organizations dealing with issues of Gynecological Oncology (ESGO, NCCN) recommend that patients with endometrial cancer undergo laparoscopic or robotic surgeryunless they live in areas where there is no hospital infrastructure or specialized Doctors (Gynecological Oncologists) to perform the operation.

If the surgical treatment of patients with endometrial cancer requires the removal of lymph nodes, how is their quick recovery ensured?

And here science has come a long way. We now know that in the vast majority of patients with endometrial cancer, screening for lymph node metastases does not require extensive lymph node cleansing. Instead, with the use of special dyes and advanced technology, we can intraoperatively identify the lymph nodes that have the highest probability of metastases. These are called sentinel lymph nodes. By removing only these and after processing them in a special way during the biopsy, we have the possibility to diagnose more metastases than in the past. In other words, with the sentinel lymph node technique, we greatly increase the accuracy in finding metastases, reduce the time of surgery, and protect our patients from complications that can affect their quality of life, such as lymphedema (swollen legs). The surgical treatment of endometrial cancer with the lymph node-sentinel technique is mainly performed laparoscopically or robotically, enabling a minimal stay in the hospital.