Learn more about this common procedure
In the United States, more than 600,000 women undergo hysterectomy each year. This makes hysterectomy the second most common operation performed on women (behind Cesarean Section) in this country. Approximately 25% of these women will undergo the procedure by age 60.
There is much confusion over the different types of hysterectomies and their meaning. First, is supracervical or partial hysterectomy. In these cases the uterus is removed but the cervix remains. In total hysterectomies, the uterus and cervix are removed. It is important to note that these terms refer only to the uterus and cervix and say nothing about the tubes and ovaries. The final type of hysterectomy is the radical hysterectomy.
This is a more aggressive technique and is typically reserved for the treatment of uterine or cervical cancer. For most women, the thought of hysterectomy brings forth concern over a long recovery and time away from work and family responsibilities. This is due to the fact that the vast majority of hysterectomies in the U.S. are performed abdominally or through the belly.
However, there are now options available in which the majority of procedures can be performed in a minimally invasive fashion with recovery times of 1-2 weeks. A total abdominal hysterectomy usually means a 4-6 inch incision on the belly, 2-4 days in the hospital, and approximately 6-8 week postoperative recovery time. Minimally invasive techniques offer much shorter hospital stays (typically one day or even outpatient surgery), quicker recovery times (1-2 weeks), and much less pain. These techniques include:
- Laparoscopic Supracervical Hysterectomy (LSH) Laparoscopic supracervical hysterectomy 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 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. 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) 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, 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 taken down, thereby making the vaginal portion of the operation more feasible.