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Hysterectomy

Hysterectomy is the surgical removal of the uterus. It is the only way to guarantee that fibroids will not recur. However, a hysterectomy is major surgery, and a woman should consider other less invasive options first. If a woman and her physician decide hysterectomy is the best option, there are less invasive approaches to performing the procedure that may lessen post-operative pain, recovery time, and scarring, compared to the traditional “open” approach.

It's a fact, 70%-90% of the 700,000 hysterectomies done yearly in the U.S. could be performed by way of a minimally invasive procedure, but aren't. What we at Virginia Hospital Center along with many past and prospective patients would like to know is, why not?

Types of Hysterectomy

  • Total hysterectomy — the uterus and cervix are removed. The ovaries and fallopian tubes may or may not be removed at the same time.

  • Subtotal or partial hysterectomy — the uterus is removed but the cervix is left in place. The ovaries and fallopian tubes may or may not be removed at the same time. Some gynecologists feel that leaving the cervix intact may reduce the chance of pelvic support problems (such as uterine-vaginal prolapse). Leaving the cervix may also help reduce the chance of developing urinary incontinence later in life. If a woman chooses this option, she should continue to have regular annual pap smears to screen for cervical cancer.

  • Radical hysterectomy — the uterus, cervix and some of the pelvic lymph nodes are removed. The ovaries and fallopian tubes may or may not be removed at the same time. This operation is performed to treat some kinds of cancer.

Different Surgical Techniques

A physician will use one of the following techniques to remove a woman’s uterus:

  • Abdominal or “open” hysterectomy — The “traditional” approach involves removal of the uterus and cervix through an abdominal incision about 4 to 6 inches in length. This approach may be recommended if a woman has large fibroids that have not responded to drug therapy or would be difficult to remove vaginally or laparoscopically. It may also be recommended to treat severe endometriosis (uterine lining tissue that has found its way out of the uterus) or pelvic inflammatory disease. This approach is performed under general or regional (spinal or epidural) anesthesia and requires a hospital stay of 3-6 days and a long recovery period (up to six weeks).

  • Vaginal hysterectomy — An approach that removes the uterus and cervix through an incision deep in the vagina. This is usually the method chosen to treat uterine-vaginal prolapse, and may be used to help treat early cervical or uterine cancer. Vaginal hysterectomy offers a shorter hospital stay (1-3 days) and less recovery time (4 weeks) compared to “open” hysterectomy. In addition, it offers the lack of visible scarring. However, this approach may not be appropriate for very large fibroids. It can be performed under general or regional anesthesia.

  • Laparoscopically assisted vaginal hysterectomy (LAVH) —This technique is similar to the vaginal approach but requires special surgical skills and instruments. A laparoscope (a thin lighted telescope) is inserted through a small incision in the navel. Other thin instruments, used to remove the uterus, can be inserted through tiny incisions. Hospital stay and recovery time is similar to vaginal hysterectomy, and like that approach, the lap-assisted approach is usually not performed if large fibroids are present.

  • Laparoscopic Supracervical Hysterectomy (LSH) — This is a recently developed surgical technique that uses laparoscopy alone to remove the uterus, but leaves the cervix intact. During the procedure, a laparoscope, and small surgical instruments are inserted through tiny incisions in the navel and abdomen. Using these instruments, the surgeon is able to carefully separate the uterus from the cervix and then remove it through one of the incisions. A surgical instrument called a “morcellator” makes it possible to cut up large sections of tissue so that they can be removed through the tiny incisions. However, this approach may not be appropriate if a woman has very large or numerous fibroids. Like LAVH, this approach requires special surgical skills.
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