Both incisions cause more adhesions, more pain, and discomfort than if the operation were done with a laparoscope. Now we know that in almost every indication these operations can be done with a laparoscope, that includes the major indications for hysterectomy. Number one, of course, would be a fibroid uterus causing bleeding, sometimes causing pelvic pressure, and rarely causing pain. Almost all of those cases could be done laparoscopically as an outpatient or a one or two day hospital stay. The other most common indication would be endometriosis.
Endometriosis can involve the uterus and it can involve the areas around the uterus.
In these women who have endometriosis who want further childbearing, the endometriosis could be removed and the uterus and one or both ovaries preserved. In these women who do not desire further childbearing, the endometriosis is probably best treated by first excision of the endometriosis where one finds it and then also a hysterectomy to remove possible deep endometriosis which is called adenomyosis - inside the uterus. So castration is not necessary. I believe that s a great advance in our thinking and our publication coming out at Columbia should be to the presses very soon where we ve shown that castration is not necessary if the surgeon has the skill and ability to remove the disease. That s one of the ways of treating endometriosis in a non-surgical way to bring the patient in and a low estrogenic phase by giving medicaments to suppress the function of the ovaries so that is something very interesting.