Hysterectomy, surgical removal of the uterus, is one of the most commonly performed gynecologic surgeries in the United States. Approximately 700,000 women undergo this procedure each year. The reasons for hysterectomy vary from endometriosis and fibroids to cancer. In this country, the majority of hysterectomies are still done through a large abdominal incision known as an abdominal hysterectomy. When done through the vagina, the surgery is called a vaginal hysterectomy. This latter method is preferable because abdominal incisions are avoided, resulting in a faster procedure with a shorter recovery time. However, for patients with complicated pathologies including endometriosis, large uterine fibroids, ovarian cyst, extensive or dense adhesions secondary to previous abdominal pelvic surgeries, a vaginal hysterectomy becomes difficult or is contraindicated. Then, a laparoscopic hysterectomy should be considered, for it has all the advantages of a vaginal hysterectomy without the large painful abdominal incisional scar. Moreover, there are fewer complications, less pain, and shorter recovery period.
In the past 20 years, advanced operative laparoscopy procedures, including laparoscopic hysterectomy, have been developed and improved substantially. The laparoscope allows the gynecologic surgeon to view the abdominal and pelvic cavity in minute detail and enables him/her to get into the right surgical planes during surgery with minimal blood loss and tissue damage. As a result of this development, gynecologists now have an advantageous alternative to abdominal hysterectomy when vaginal hysterectomy is difficult, complicated, or deemed contraindicated.
Laparoscopic hysterectomy is an advanced procedure which uses the laparoscopic technique partly or completely to perform a hysterectomy. Depending on the degree of laparoscopic technique used during the hysterectomy, the surgery may be categorized as one of the following:
- Laparoscopic Assisted Vaginal Hysterectomy (LAVH). Only a small portion of the hysterectomy is done with the laparoscope, with the rest of the procedure performed through the vagina. Laparoscopic assisted vaginal hysterectomy (LAVH) does not include occlusion and division of uterine arteries in the laparoscopic portion of hysterectomy.
- Laparoscopic Hysterectomy (LH). Most of hysterectomy is done by laparoscopic technique, including the occlusion and division of both uterine arteries. The vaginal branch of uterine vessels are secured and divided vaginally and also the top of vagina is separated from the cervix vaginally.
- Total Laparoscopic Hysterectomy TLH). The entire hysterectomy is performed laparoscopically. The surgeon does not perform any portion of the procedure vaginally. The technique of total laparoscopic hysterectomy enables the gynecologic endoscopic surgeon to perform larger and more difficult hysterectomies. Total laparoscopic hysterectomy (TLH) requires advanced surgical skills on the part of gynecologist whose experience and proficiency are paramount in performing successful operative laparoscopy.
Different Types of Hysterectomies
All hysterectomies are major operations involving removal of at least the uterus. Some types of hysterectomies involve removing other organs as well. It is important to know about the kind of hysterectomy recommended for you.
- Subtotal Hysterectomy or Supracervical Hysterctomy. In this operation, only the upper part of the uterus is removed, but not the cervix. Tubes and ovaries may or may not be removed. This procedure can easily be done laparoscopically. It is controversial whether or not leaving the cervix in will help with later sexual enjoyment. After surgery, the patient still needs to have regular Pap smears to prevent cervical cancer.
- Total Hysterectomy. This operation involves removing both the body of the uterus and the cervix. This is by far the most common type of hysterectomy performed in United States. "Complete hysterectomy" is a common non-medical term that usually means a total hysterectomy plus removal of ovaries and fallopian tubes.
- Radical Hysterectomy. This procedure is reserved for serious disease such as cancer. The entire uterus and usually both tubes and ovaries as well as lymph nodes in the pelvis and low abdomen are removed.
At the Women's Surgery Center, all hysterectomies are totally done laparoscopically. Dr. Liu was one of the pioneer s of this technique, which has revolutionized surgical treatment from the century-old abdominal and vaginal hysterectomies to the current minimally invasive procedure. Since our practice is primarily a referral practice, all our surgeries are video taped for the benefit and information of the referring physician, and a copy of the videotape is given to the patient for her own reference as well.