A hysterectomy is one of the most common surgical procedures performed on women, second only to the Cesarean Section. In the United States more than 600,000 women undergo hysterectomy procedures each year. For most women the thought of a hysterectomy brings forth concerns over a long and painful recovery as well as time away from family and work responsibilities.
The majority of hysterectomies in the United States today are done through major abdominal surgery. This involves several days in the hospital and 6-8 weeks of recovery before resuming normal activities. There are circumstances where this may be the technique of choice, but there are options available in which a hysterectomy can be performed in a minimally invasive fashion with an overnight hospital stay and recovery times of 1-2 weeks.
There are several different types of hysterectomies. This can be somewhat confusing. In a partial, or supracervical, hysterectomy, the uterus is removed but the cervix remains intact. In a total hysterectomy, the uterus and cervix are removed. It is important to note that these terms refer only to the uterus and the cervix but say nothing about the fallopian tubes or ovaries. Finally, the radical hysterectomy is a more aggressive technique typically reserved for the treatment of uterine or cervical cancer.
The majority of women having a hysterectomy in our country will undergo a total abdominal hysterectomy. This usually means a 4-6 inch incision on the belly, 2-4 days in the hospital, and approximately 6-8 weeks for postoperative recovery. Minimally invasive techniques offer much shorter hospital stays and in some cases are done as an outpatient procedure. The recovery time is much shorter, usually 1-2 weeks. Another major benefit of these procedures is that it is less painful than other options. The minimally invasive techniques include:
- Laparoscopic Supracervical Hysterectomy (LSH) is perhaps the newest hysterectomy technique. During LSH the uterus is separated from its pelvic supports and blood supply. The cervix is left intact with the uterosacral ligaments attached (these are the main supporting structures of the vagina). The uterus is then removed via a specialized instrument called a morcellator. Patients usually have three small incisions (approximately ½ 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) 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 which include laparoscopic suturing. Again, most patients will have three small incisions, be home from the hospital within 24 hours and return to full activity in 2-3 weeks.
- Total Vaginal Hysterectomy (TVH) utilizes any incision 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) combines vaginal hysterectomy with laparoscopic techniques. Many times, LAVH is performed when there is pelvic pain, ovarian masses, or other reasons that make TVH alone impossible or less ideal. With the aid of laparoscopic techniques, the ovaries, tubes, uterus and other pelvic structures can be directly visualized. The upper support and blood supply of the uterus can be separated, thereby making the vaginal portion of the operation more feasible.
With new and better surgical equipment, more women are candidates for Minimally Invasive Procedures. These techniques will allow for a shorter recovery times and a quicker return to normal activities. In some cases, the cervix is left intact, which may reduce sexual and pelvic support problems sometimes seen after hysterectomy. It is important to discuss your options and be comfortable with the surgical plan before undergoing any procedure. If you would like to review more information on hysterectomy, please take time to visit these websites:
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