Hysterectomy

Abdominal hysterectomy (TAH)

The conditions that usually necessitate an abdominal hysterectomy, are cancer, overwhelming infection, extremely large fibroid tumors, and advanced endometriosis.  An abdominal hysterectomy requires both a vaginal incision and a four to six inch incision in the lower abdomen. The uterus is removed, and in most cases the cervix is removed as well. The fallopian tubes and ovaries can be removed if patient and doctor agree to this prior to surgery.  The hospital stay is generally 2-3 nights, and the recovery time is 6-8 weeks. Due to the large incision, there is often unfortunately considerable postoperative pain. The recuperative process will be a long one, and the scar will be permanent. There are risks to any surgery, but the risks of the abdominal hysterectomy are greater than the risks of the vaginal hysterectomy or the laparoscopic hysterectomy. General anesthesia, which is required for the abdominal hysterectomy and the risks of infection, bleeding, blood clotting, or possible damage to other organs are also greater Women who are overweight, who smoke or have other medical problems will be at greater risk during any kind of surgery.  Approximately 800 hysterectomies are performed in the Asheville area annually. Of these, about 75% are done using abdominal wall incisions. Only 25% are done transvaginally. In contrast, our group's vaginal hysterectomy rate approaches 75%. In other words, we do 75% of our hysterectomies vaginally compared to the rest of the community that is doing only 25% vaginally thus denying you many of the benefits of the vaginal approach.  Up to 75% of patients who need hysterectomies are good candidates for the vaginal hysterectomy. Chances are, if you need a hysterectomy, you would be a good candidate. If a hysterectomy has been recommended and you have not been offered the vaginal approach we invite you to consider a consultation with one of our doctors.

Laparoscopic Assisted Vaginal Hysterectomy (LAVH)

 The Laparoscopic Hysterectomy is very similar to the Vaginal Hysterectomy - the difference being that a laparoscope is used to assist in the removal of the uterus.  Laparoscopy was pioneered by gynecologists in the early 1960s, and has been widely used in a range of procedures, including tubal ligation, the removal of ovaries and fibroid tumors, and the treatment of tubal pregnancies. 

The benefits of a laparoscopic hysterectomy over an abdominal hysterectomy are:

• Increased safety.
• No visible scars.
• Much less pain.
• Increased safety.
• Faster recovery.
• Lower cost.

The technique of laparoscopic hysterectomy was developed in 1989, when several laparoscopic hysterectomies were performed with very successful results. With this procedure, a laparoscope (a tiny telescope) is inserted through a small incision in the navel. Thus the surgeon can view a magnified image of the patient's internal organs on a video monitor. This procedure enables the surgeon to perform the hysterectomy, as well as to diagnose and treat related conditions at the same time. Often, one or two additional small (1/4") incisions are made elsewhere in the lower abdomen, in order to allow the use of other tiny surgical instruments. These tiny incisions are closed with sutures or surgical tape. Within a few months, the incisions are barely visible.  With laparoscopic hysterectomy the vascular pedicles are secured and the uterus freed from the ligamentous attachments .The fallopian tubes and ovaries can be removed in this way as well if clinically indicated The uterus can then be removed through a vaginal incision, much like a vaginal hysterectomy. The patient is under general anesthesia throughout the procedure.  Because you could greatly benefit from having a laparoscopic hysterectomy instead of an abdominal hysterectomy consider a consultation with one of our doctors about this surgical approach. 

Vaginal hysterectomy (TVH)

If you need a hysterectomy, there is a better way. It's called "Vaginal Hysterectomy". This type of surgery frees you from the large incision that is normally required for a hysterectomy. The uterus is removed at its internal source instead - the upper end of the vagina. Small retractors and special headlights are used in the surgery. The ovaries can also be removed during this surgery if clinically indicated. The vagina is not harmed or stretched in anyway. If the uterus is enlarged by tumors these can be removed in small sections through the vagina using a technique called morcellation. 

The benefits of a Vaginal Hysterectomy are:

• Increased safety.
• No visible scars.
• Much less pain.
• Increased safety.
• Faster recovery.
• Lower cost.

If you and your gynecologist have decided that a hysterectomy is indicated, then the next most important decision you need to make is which way the surgery should be performed. We would like you to be informed as you consider this important decision.

Surgical skill, experience, and complication rates vary among gynecologists. Since the vaginal approach requires the most skill and experience, your gynecologist may not be comfortable in offering this minimally invasive technique to you. In addition some gynecologists are still telling patients that the vaginal hysterectomy cannot be done if the patient has never had a baby, has had a previous cesarean section, has large tumors of the uterus (fibroids) or needs to have the ovaries removed as well. Our doctors do not consider these conditions as contraindications to the vaginal approach.

If your hysterectomy is scheduled for the laparoscopic or abdominal approach consider a visit to our office and see why we can offer you the vaginal approach most of the time.

© Grace OB-GYN