Hysterectomy

Types of Hysterectomies

It used to be that total abdominal hysterectomy (removal of the uterus and cervix through a large abdominal incision) was the only type of hysterectomy offered to women. But today, the development of improved surgical devices and innovative techniques allows for less invasive procedures that can remove the uterus but can sometimes allow you to keep your cervix, ovaries and fallopian tubes. Hospital stays, and recovery times, have also been reduced.
Although some medical conditions may require specific techniques, it is important to know what your options are and to discuss them with your doctor.

What are the different ways to perform a hysterectomy?

• Total abdominal, or open, hysterectomy
• Vaginal hysterectomy
• Laparoscopically-assisted vaginal hysterectomy (LAVH)
• Laparoscopic supracervical hysterectomy (LSH) - a minimally invasive and less traumatic procedure resulting in a shorter recovery time

Total abdominal, or open, hysterectomy

The "traditional" hysterectomy - involves removal of the uterus and cervix (with or without removal of the ovaries or fallopian tubes) through a large abdominal incision. This is the most invasive type of hysterectomy, and also the most common. Total abdominal hysterectomy may be recommended if you have large fibroids that have not responded to hormone therapy or would be difficult to remove vaginally. It also may be the preferred procedure if you have severe endometriosis (uterine lining tissue that has found its way out of the uterus), pelvic infections, scarring from prior pelvic surgeries, or some types of cancer.

Total abdominal hysterectomy is performed under general or regional anesthesia, and requires a hospital stay of 3-6 days and a long recovery period (up to 6 weeks). Abdominal hysterectomy leaves a visible scar on your abdomen.

Vaginal Hysterectomy

Vaginal hysterectomy is a procedure that removes the uterus and cervix through an incision deep inside the vagina. This is usually the method chosen to treat uterine-vaginal prolapse, and may also be used to help treat early cervical or uterine cancer.

A vaginal hysterectomy may result in less post-operative discomfort than you would feel after a total abdominal hysterectomy. Other advantages include a shortened hospital stay (1-3 days) and recovery time (4 weeks), and the lack of visible scarring. However, vaginal hysterectomy is not appropriate if very large fibroids are present. The procedure can be performed under general or regional anesthesia.

Laparoscopically-assisted vaginal hysterectomy (LAVH)

Laparoscopically-assisted vaginal hysterectomy (LAVH) is similar to a vaginal hysterectomy - the uterus and cervix are removed through an incision deep inside the vagina - but also includes the use of a laparoscope (a thin, lighted telescope) which is inserted through a small incision in the navel.

Use of a laparoscope allows the upper abdomen to be carefully inspected during surgery and allows the surgeon to perform part of the surgery through tiny incisions. As with vaginal hysterectomy, LAVH usually cannot be performed if very large fibroids are present. Hospital stay and recovery time are similar to simple vaginal hysterectomy. The combination of vaginal hysterectomy with laparoscopic technique requires more skill to perform and more time in the operating room than total abdominal or vaginal hysterectomy procedures.

A newer, even less invasive and less traumatic surgical technique is called laparoscopic supracervical hysterectomy.

Laparoscopic supracervical hysterectomy (LSH)

Laparoscopic supracervical hysterectomy (LSH) uses a thin, lighted telescope-like instrument called a laparoscope, which acts like a video camera, along with small surgical instruments that are all inserted through three to four tiny incisions (less than 1/4 inch each) in the navel and abdomen. Using the instruments, the surgeon carefully separates the uterus from the cervix and removes it through one of the openings. The cervix, the bottom part of the uterus, is left intact. Because this type of surgery does not require the surgeon to make a large abdominal incision, you will not have the same kind of visible scar typical with most traditional, "open" surgeries.

LSH causes less stress to the body than the traditional "open" hysterectomy. It was developed to reduce pain, minimize scarring, and shorten recovery time. The procedure can be done on an outpatient basis, which means a woman can be home resting comfortably within 24 hours and back to her normal activities in less than a week. As with all surgery, hysterectomy involves risk, including potential blood loss, infection and damage to other internal organs.

LSH preserves the cervix, which some research suggests may help to reduce the risk of pelvic floor prolapse, urinary incontinence and other complications associated with total hysterectomies. Because the cervix is left in place, however, you must be willing to continue annual pap smears to screen for cervical cancer.

© 2007 Women Partners in OB-GYN