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Same-day hysterectomies safe, effective. So why aren't there more in Canada?
Hysterectomy -- surgery to remove the uterus is one of the most commonly-performed surgeries in Canada. It's major surgery, but for many women dealing with painful fibroids, heavy bleeding, or other problems, it's a life-changing procedure.
In recent years, surgeons have been moving to simpler surgeries using advanced laparoscopic equipment and smaller incisions. Studies show that the approach shortens both the surgery and that recovery time so much that many patients can be discharged the same day.
But with few surgeons in Canada trained in the technique, many Canadian women have no other option but to choose traditional surgery and up to six weeks of uncomfortable recovery.
Sue Blackie is one of those who opted for same-day laporoscopic hysterectomy. The Ottawa mother of three, who's also a caregiver to her aging parents, decided she couldn't afford two days in hospital and weeks of recovery.
"I was aware it would take a couple of months to recover, and there was no way I could do that," she said.
She pushed her doctor to find an alternative and learned that a surgeon at the Ottawa Hospital could offer her the minimally invasive laporoscopic surgery and same-day discharge.
She had to wait for more than five months to get the surgery but finally had the procedure last November. She went into surgery at 1 p.m. and was back in her own home by 9 p.m. that night.
She even went to a party two days later, and meetings the following week.
"I was so pleased, it was amazing. It was not a big deal at all," she said.
In a traditional hysterectomy, a large incision is made in the abdomen and the uterus is removed. In the laporoscopic approach, the uterus is removed through a keyhole-sized incision using tiny cameras to guide the work.
Women can be sent home early with doctors following up on their recovery at home via phone calls.
Two recent studies have found that discharging patients the same day as their laporoscopic hysterectomy is both safe and cost-effective.
One soon-to-be published study from McMaster University researchers found that, among "outpatient hysterectomy" patients, 79.1 per cent were able to be discharged the same day, while another 17 per cent left the next day. Only 3.9 need to be admitted for two or more days.
There were no significant differences in complication rates among the patients , fewer rates of infections and the quick discharge frees up hospital bed for other patients.
Same-day discharges are already commonly used for other surgeries, such as gallbladder removals, but in Canada, laporoscopic hysterectomies are taking longer to be embraced. The procedure is offered at only a few Canadian hospitals and few doctors are being trained in the technique.
Dr. Sony Singh, the vice-chair of gynecology at the Ottawa Hospital, says patient satisfaction rates are also high. He wonders why the procedure isn't offered to more women.
"There's no question in my mind that we need to do this for more women and it's the right way to go," he said.
And yet, of the thousands of Canadian women eligible for this approach, the majority are still being offered the traditional operation, with the long recovery time.
"I think that we need to do a lot more work to be able to make this available to everyone across Canada when it's appropriate, but we're not there yet," says Dr. Nicholas Leyland, the chief of obstetrics and gynaecology at Hamilton Health Sciences.
And, Leyland says, patients need to be their own best advocate, when looking for alternatives to the traditional surgery.
Sue Blackie says, if she hadn't pushed her doctor for an alternative, she would have ended up with the old-style hysterectomy.
"I know a lot of women who have had the surgery; none had laparasopic I wish they knew this was an option, " says Blackie.
Leyland says more surgeons need training in the technique, and more hospitals need to invest in the specialized equipment.
"The women of Canada deserve this option, they benefit as do their families and their employers" says Dr. Leyland.
With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip