Hysterectomy

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

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 laparoscopy.

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.

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, 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.