Hysterectomy can be done using one of several techniques or a combination of these techniques.
- The most common technique many gynecologists now use is the laparoscopically-assisted vaginal hysterectomy (or LAVH).
- Hysterectomy may also be performed entirely through a larger incision in the lower abdomen (TAH or total abdominal hysterectomy). Occasionally, the initial approach to hysterectomy may be laparoscopic or vaginal, and the surgery may have to be completed through an abdominal incision due to adhesions or scar tissue, bleeding, the size of the uterus or other factors that prevent the procedure from being completed laparoscopically or vaginally.
- The hysterectomy may be done entirely through the vagina (TVH or total vaginal hysterectomy).
Choosing the Kind of Hysterectomy
Choosing which technique depends on a number of factors such as:
- the size of the uterus relative to the size of the pelvis (birth canal)
- whether or not the tubes and ovaries are to be removed
- whether or not endometriosis or scar tissue is suspected
- the presence of cancer
- whether or not other procedures are to be performed at the same time as the hysterectomy. Complete or partial removal of other abdominal and pelvic organs such as ovaries, fallopian tubes, and appendix may be completed along with hysterectomy as well as placement of a sling for urinary incontinence/
- the skill of the surgeon. Some physicians are particularly skilled at laparoscopic or vaginal surgery, making recovery much easier and quicker. If your physician suggests you have surgery through a large abdominal incision, ask if it is possible to complete the procedure either laparoscopically or vaginally.
Laparoscopically-Assisted Vaginal Hysterectomy
LAVH involves the use of a laparoscope to perform most of the surgery. The tissue is then removed through the top of the vagina. The LAVH is appropriately used in place of the abdominal hysterectomy; it is not meant to replace procedures that can be easily accomplished entirely through the vagina. Occasionally, the entire procedure is completed laparoscopically (or laparoscopic hysterectomy) and the tissue removed through a lower abdominal incision approximately 1 inch long.
Many patients after having a laparoscopically-assisted or vaginal hysterectomy are able to leave the hospital in less than 24 hours (if a larger abdominal incision is necessary, the usual stay is several days, and return to normal activity is delayed by at least 2-4 weeks.
Supra-cervical vs. Total Hysterectomy
Over the past several years, laparoscopic supra-cervical hysterectomy has become a more popular procedure – mainly due to promotion by a company that sells surgical equipment necessary to perform the procedure. Before physicians and patients embrace this procedure, certain questions should be answered. What are the advantages of this procedure? Are there any disadvantages? What are the costs? Are the costs justified?
Invalid arguments for considering supra-cervical hysterectomy over total hysterectomy include:
- Improved sexual function – A number of recent well-designed medical studies have shown sexual function is improved equally with supra-cervical and total hysterectomy.
- Improved pelvic support with less urinary incontinence – Over fifty percent of women over the age of fifty have some degree of uncontrollable urinary loss, frequently associated with decreased support of the bladder. Some medical studies show improvement in urinary function with both supra-cervical and total hysterectomy. One study showed more women had urinary incontinence after undergoing supra-cervical than those having total hysterectomy.
- Decreased surgical complications – The incidence and type of complications for supra-cervical and total hysterectomy are similar.
Cyclic bleeding occurs in up to 20% of women after supra-cervical hysterectomy. The upper part of the cervix that is left with supra-cervical hysterectomy may contain tissue that responds to hormones, resulting in bleeding. Additionally, 25% of women having supra-cervical hysterectomy will require further surgery due to abnormal bleeding or abnormal PAP smears of the cervix.
Laparoscopic supra-cervical hysterectomy may offer a slight benefit of quicker initial recovery, but for most women removal of the cervix along with the body of the uterus is the preferred procedure when hysterectomy is indicated. You should discuss your options with your physician.
The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.