Hysterectomy is removal of the uterus. It may be done alone or combined with other procedures such as suspension for prolapsed or dropping bladder or vagina. A hysterectomy can be total (removal of the uterus with the cervix) or subtotal (removal of the uterus leaving the lower part, called the cervix, in its normal place at the top of the vagina). The subtotal hysterectomy is also called a supracervical hysterectomy. Note that a total or subtotal hysterectomy DOES NOT INVOLVE THE REMOVAL OF THE OVARIES.
Vaginal Hysterectomy (total vaginal hysterectomy, or TVH) is performed by removing the uterus through the vagina with no abdominal incision. This can also be combined with other procedures such as removal of the ovaries and is often combined with vaginal or bladder suspension procedures. It has the advantages of a more rapid recovery than abdominal hysterectomy and no abdominal scar. Vaginal hysterectomies have the disadvantage of working through a small incision and difficulty seeing the pelvic organs.
Laparoscopy is the name given to surgery that uses a small scope to view the pelvic organs. The scope is inserted through a small incision either at the umbilicus or in the upper abdomen, and other instruments are inserted into the abdomen through small incisions to perform surgical procedures without having to make large incisions or place the surgeons hands into the abdominal cavity. Laparoscopy has the advantages of shorter hospital stays , avoiding large abdominal incisions, usually much less pain than a laparotomy, and a more rapid recovery. The laparoscope can often provide a better view of the pelvic organs than laparotomy. Laparoscopy is used for many procedures that have traditionally been done with laparotomy, and is often used when performing a hysterectomy. Most laparoscopic procedures are done using three or four small incisions, but the number of incisions can vary from one, up to five, and occasionally more.
Laparoscopic Assisted Vaginal Hysterectomy (LAVH)
Laparoscopic assisted vaginal hysterectomy (LAVH) is a type of vaginal hysterectomy that is combined with laparoscopy. Part of the procedure is done through the laparoscope, thus avoiding the increased pain, large abdominal scar and slower recovery of an abdominal hysterectomy. This is usually done when part of the surgery would be difficult to perform through the vaginal incision or there is a need look into the pelvis to check for problems that cannot be seen through the vagina.
Laparoscopic Total Hysterectomy (LTH)
Laparoscopic total hysterectomy (LTH) is removal of both the uterus and cervix where all of the procedure is performed through the laparoscope. This is often done with other laparoscopic procedures, and may have the advantages of less pain, quicker recovery and fewer complications than abdominal, vaginal or laparoscopic assisted vaginal hysterectomy. After the uterus has been freed from its attachments inside the pelvis, it may be removed either through the vagina or by a procedure called morcellation. Morcellation is a process that involves cutting or shaving the uterus into small sections that can then be removed through the small laparoscopic incisions. Very large uterine tumors can sometimes be removed without the need for a large abdominal incision.
Find out what to expect while having a laparoscopic total hysterectomy. Download our detailed PowerPoint presentation.
Laparoscopic Subtotal (or Supra-Cervical) Hysterectomy (LSH)
Laparoscopic subtotal (or supra-cervical) hysterectomy (LSH) is similar to laparoscopic total hysterectomy in that the procedure is done completely through the laparoscope, but rather than cut across the upper vagina to remove the cervix and uterus, the cervix is left attached to the vagina and the uterus removed from the cervix. The uterus is then morcellated and removed from the abdomen through one of the laparoscopy incisions. The LSH usually has the shortest recovery time, and much less pain and a lower rate of infection than other forms of hysterectomy.
Robotic Assisted Hysterectomy (RAH)
Robotic assisted hysterectomy, or robotic assisted laparoscopic hysterectomy (RALH) is a form of laparoscopic hysterectomy using robotic technology to assist the surgeon. In this procedure, the surgeon sits at a control station (console) a few feet from the operation table looking at a monitor that provides a three dimensional view (possible because the scope used in robotic surgery is actually two small scopes that provide binocular vision). The console controls the robot device that has three or four arms for operating instruments plus controls to move, zoom and focus the scope with its attached camera. Both hand controls and foot pedals are used to control the instruments that can grasp, cut, burn, cauterize and suture inside the pelvis. In addition to the robot with its three or four arms and scope, there is an additional small incision used by an assistant surgeon who stands at the patient’s side as is normally done with traditional laparoscopy. Most robotic surgeries use from four to six incisions. The advantages of robotic surgery are the improved vision with a three dimensional view, markedly improved ability to manipulate the surgical instruments due to the “wrist action” of the robotic instruments, and usually less post operative pain despite the larger and more numerous incisions than are used in traditional laparoscopy. Robotic surgery has made some surgical procedures possible or easier that would be extremely difficult or impossible with traditional laparoscopy.
Single Incision Laparoscopic Surgery (SILS)
Single incision laparoscopic surgery uses most of the same instruments as traditional laparoscopy, but rather than three or four separate incisions for two or three separate laparoscopic instruments plus a laparoscopic camera, the camera with its scope and all the instruments are inserted through a single incision at the umbilicus. This one incision is larger than the usual laparoscopic incisions, but the one incision can often be partially hidden in the umbilicus and leaving less pain and less abdominal scarring than the three or four laparoscopic incisions.
Laparotomy is the name given to abdominal incisions. These incisions can be vertical (up and down the midline of the lower abdomen) or transverse (side to side very low on the abdomen). In cases where the uterus is too large, a hysterectomy may be performed through an abdominal incision. If this is the case, you will be required to stay in the hospital for an additional 2-3 days to recover and your recovery at home may be as long as six to eight weeks. Because minimally invasive surgery is more advantageous for the patient, our providers will recommend a vaginal, laparoscopic or robotic hysterectomy first and reserve the more invasive abdominal hysterectomy for patients who are not candidates for minimally invasive surgery.
To learn more about the all the hysterectomy options available at Advanced & Minimally Invasive Gynecology, contact our practice.