Photo by Emma Simpson
This common procedure has improved in recent years. Learn more about the newest techniques.
In the United States, 22 million women have had a hysterectomy. Every year, another 600,000 women have the procedure. One-third of all American women have likely had a hysterectomy by age 60. The hysterectomy is the second most frequent operation for women of reproductive age. Only the frequency of the Cesarean Section is greater.
Despite common belief, this common procedure is not only a cancer-fighting surgery. In fact, hysterectomies are most often considered for other diagnoses. Common indications for non-cancerous hysterectomies are leiomyoma, menstruation/reproductive disorders, and endometriosis.
Types of Procedures
The term hysterectomy covers many types and different procedures. A supracervical (or partial) hysterectomy removes only the uterus – leaving the cervix in situ. The term “hysterectomy” refers only to the uterus and cervix. Removal of fallopian tubes and ovaries are a different procedure, though the procedures may happen in conjunction at times.
In a total hysterectomy, the cervix and the uterus are both removed. This is a greater surgery, and may often include an oophorectomy, the additional procedure mentioned above.
The final procedure is the radical hysterectomy. Also a total hysterectomy, it can include removal of all sex organs, lymph nodes, parametria and the upper vagina. This is the least common, reserved for the direst of diagnoses, such as for the treatment of uterine or cervical cancer.
Common Worries Surrounding A Hysterectomy
The thought of hysterectomy brings forth concern, not only considering the surgery. In the past, the vast majority of hysterectomies in the U.S. were performed through the abdomen. Knowing this, many prospective patients worry about a long recovery time; a common concern is the procedure may mean time away from work and family responsibilities.
While this used to be the case, techniques and technology has advanced.
The majority of procedures now performed are in a minimally invasive fashion. A partial hysterectomy is now expected to exhibit recovery times of one to two weeks. Even the more intensive total abdominal hysterectomy requires only a few days of hospital recovery. The procedure requires a 4-6 inch incision on the belly and a brief hospital stay, usually two to four days. Postoperative recovery time for a total hysterectomy averages around six to eight weeks. Along with shorter hospital stays and quicker recovery times, these minimally invasive techniques often offer less pain and discomfort.
Know the Newest Techniques
Historically, the procedure followed roughly the same surgery pattern as a C-section delivery. These new techniques, listed below, are quite different from their traditional history.
These techniques include:
- Laparoscopic Supracervical Hysterectomy (LSH)
The laparoscopic supracervical hysterectomy is one of the newest hysterectomy techniques. During LSH the uterus is separated from its pelvic supports and blood supply. The uterus is then removed with a specialized instrument called a morcellator. The cervix remains intact with the uterosacral ligaments attached. (These ligaments are the main supporting structures of the vagina). Patients usually have three small incisions (approximately 1/2 inch), are at home within 24 hours of surgery, and can be back to normal activities in less than a week.
- Total Laparoscopic Hysterectomy (TLH)
Total laparoscopic hysterectomy is similar to LSH but the cervix is also removed. Newer instruments such as the harmonic scalpel have made this procedure possible. TLH represents a technically difficult procedure and requires the surgeon to be skilled in additional laparoscopic techniques, including laparoscopic suturing. Like the LSH, most patients will have three small incisions, arrive home within 24 hours and return to full activity in 2-3 weeks.
- Total Vaginal Hysterectomy (TVH)
With total vaginal hysterectomy, an incision is made around the cervix through the vagina. The uterus and cervix are then removed vaginally. With this technique, there is no visible incision or scarring. Most patients will stay 1-2 days in the hospital after TVH and return to normal activities in 1-2 weeks.
- Laparoscopic-Assisted Vaginal Hysterectomy (LAVH)
Laparoscopic-assisted vaginal hysterectomy combines vaginal hysterectomy with laparoscopic techniques. Many times, LAVH is performed when there is pelvic pain, ovarian masses. These, or other less common reasons, make other techniques impossible or not ideal. With the aid of laparoscopic techniques, the ovaries, fallopian tubes, uterus and other pelvic structures can be directly visualized. The upper support and blood supply of the uterus is removed first. This makes the vaginal portion of the operation more feasible.