Hysterectomy is the surgical removal of the uterus. This is one
of the most commonly performed gynecologic surgeries in the United
States. Approximately 700,000 women undergo the procedure each year.
The reasons for hysterectomy vary from endometriosis and fibroid
to cancer. In this country, the majority of hysterectomies are still
done through a large abdominal incision or abdominal hysterectomy.
Another method of performing a hysterectomy is through the vagina
or vaginal hysterectomy. This method is the preferred method compared
to abdominal hysterectomy, because it avoids any abdominal incision
and is a faster procedure with a decreased recovery time. However,
when patients with complicated pathologies including endometriosis,
large uterine fibroids, ovarian cyst, extensive or dense adhesions
secondary to previous abdominal pelvic surgeries, vaginal hysterectomy
becomes difficult or is contraindicated. Then, a laparoscopic hysterectomy
should be considered, for it has all the advantages of vaginal hysterectomy
without the large painful abdominal incisional scar and prolonged
recuperation time required for abdominal hysterectomy.
In the past ten years, advanced operative laparoscopy, including
laparoscopic hysterectomy, has been developed and much improved.
Laparoscopic hysterectomy incorporates all the advantages of vaginal
hysterectomy and abdominal hysterectomy. The laparoscope allows
the gynecologist to view the abdominal and pelvic cavity in minute
details and enable the surgeon to get into the right surgical planes
during surgery with minimal blood loss and tissue damage, while
avoiding a large abdominal incision and scar. As a result of this
development, gynecologists have an alternative to abdominal hysterectomy
when vaginal hysterectomy is difficult, complicated or deemed contraindicated.
Laparoscopic hysterectomy refers to using laparoscopic technique
partly or completely to perform hysterectomy. Depends on the extended
degree of using laparoscopic technique during hysterectomy, it can
be categorized into three subgroups:
Laparoscopic Assisted Vaginal Hysterectomy (LAVH)
It denotes to only a small portion of hysterectomy is done with
the laparoscope, the rest of the procedure is performed through
vagina. Laparoscopic assisted vaginal hysterectomy (LAVH) does not
include occlusion and division of uterine arteries in the laparoscopic
portion of hysterectomy.
Laparoscopic Hysterectomy (LH)
In 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 go below and perform any portion of hysterectomy vaginally.
The technique of total laparoscopic hysterectomy, where the vaginal
portion is totally eliminated, broadens the limits of this type
of surgery allowing larger and more difficult hysterectomies to
be performed laparoscopically. Total laparoscopic hysterectomy (TLH)
requires much more surgical skills on the part of gynecologist who
must be very experienced and proficient in performing operative
Different Types of Hysterectomies
All hysterectomies are major operations involving removal of at
least the uterus. Some types of hysterectomie 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 opration, only the upper part of the uterus is removed,
but the cervix is not. Tubes and ovaries may or may not be removed.
This procedure can also easily be done laparoscopically. It is controversial
whether or not by leaving the cervix will help with later sexual
enjoyment. After this operation, a woman still needs to have regular
Pap smears to prevent cervical cancer.
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.
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, hysterectomies, when done
laparoscopically, are done with total laparoscopic hysterectomy
(TLH). Dr. Liu was one of the physicians to pioneer this new
technique. Since our practice primarily is a referral practice,
for the better communication with and the benefit of referring physicians,
all our surgeries are video taped. Our patients can also request
the tapes of their surgeries for their own reference.