Hysterectomy Options

October 10, 2010

Abdominal hysterectomy (removal of the uterus and cervix through a large abdominal incision) is what people traditionally think of when they refer to a hysterectomy. However, with the development of advanced techniques and surgical equipment, less invasive hysterectomy options are readily available by selectively trained surgeons.

Abdominal hysterectomy (removal of the uterus and cervix through a large abdominal incision) is what people traditionally think of when they refer to a hysterectomy. However, with the development of advanced techniques and surgical equipment, less invasive hysterectomy options are readily available by selectively trained surgeons.  There are several different ways to perform a minimally invasive hysterectomy.  The chart and descriptions below provide detailed information about your hysterectomy options and the risks and benefits associated with each.  Talk with your physician about the option that best suits your needs and your lifestyle.

Laparo-Endoscopic Single-Site (LESS) Hysterectomy

This minimally invasive procedure is done through an approximately one inch single incision in the belly button. After the LESS hysterectomy, the incision is covered by the natural contours of the belly button hiding the scar. This new advanced surgical technique reduces the pain and minimizes the scarring compared to open surgery, and typically requires only one day in the hospital, and generally you're back to your normal routine within a few weeks.

Laparoscopic Supracervical Hysterectomy (LSH)

A Laparoscopic Supracervical Hysterectomy (LSH) involves only a few small incisions (½ inch or less) in the abdomen resulting in minimal scarring. A laparoscope, which contains a fiber optic light and a magnifying video camera, is inserted through an incision in the navel to help guide the physician and allow them to see inside the abdomen. Small surgical instruments needed to perform the surgery are inserted into the other incisions. During an LSH, the uterus is removed through one of the small openings but the cervix is preserved (thus the term Supracervical). The cervix used to be removed for fear of cervical cancer. However, risk of cervical cancer is just over 0.1% and can be screened for with an annual pap smear. Meanwhile, studies have shown that the cervix is important for pelvic support and possibly sexual satisfaction. It should only be removed when necessary. In cases where it is necessary to remove the cervix, a Total Laparoscopic Hysterectomy (which includes the removal of the cervix) may be performed. LSH requires a hospital stay of 1 day or less and is often done in an outpatient setting. Average recovery time is only 2-3 weeks.

Total Laparoscopic Hysterectomy (TLH)

TLH is another minimally invasive option that is similar to the LSH procedure. The main difference is the cervix is removed with the uterus. The fallopian tubes and/or ovaries may or my not be removed.

Vaginal Hysterectomy

Vaginal hysterectomies are a less invasive procedure than the traditional abdominal hysterectomy. An incision is made in the vagina and the uterus and cervix are removed vaginally. It requires a shorter hospital stay of 1-3 days and an average recovery time of 4 weeks.

Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

LAVH is similar to a Vaginal Hysterectomy but also includes the use of a laparoscope and small surgical instruments which are inserted through tiny incisions in the naval and abdomen. This allows the surgeon to perform part of the surgery through the tiny incisions and carefully inspect the abdomen during surgery. The uterus is then removed vaginally. Hospital stay and recovery time are similar to that of a vaginal hysterectomy.

Abdominal Hysterectomy

This procedure involves a 6-8 inch incision across the abdomen to remove the uterus and cervix. An abdominal hysterectomy is the most invasive option and will take the longest to recover. Patients generally stay in the hospital for 5-6 days and require at least a 6 week recovery time. A visible scar will be left on the abdomen. Due to a slow adoption of technology, the majority of hysterectomy procedures are still being performed in this fashion.

Risks of Surgery

Before making your decision to have surgery, it is important to understand the risks. There is always a probability that your laparoscopic hysterectomy may be converted to an open procedure if there are unforeseen complications during your procedure such as difficult anatomy or excessive bleeding. While major risks are rare, all surgery should be considered carefully. With all surgery, including laparoscopic surgery, there are the typical risks of reactions to medications or problems resulting from the anesthesia, bleeding, infection, problems breathing, blood clots in the veins or lungs, inadvertent injury to other organs or blood vessels near the uterus, and even death, which is rare. The risk for serious complications depends on the reason the surgery is needed and your medical condition and age, as well as on the experience of the surgeon and anesthesiologist. Ask your doctor or surgeon what you should expect after surgery, as well as the risks that may occur with surgery

Additional Risks of Abdominal Hysterectomy
In addition to the general risk of surgery, a traditional abdominal hysterectomy can present additional risks including muscle injury and postoperative hernia in the incision site.

Alternatives to Hysterectomy
If you determine that you are not ready for surgery, you may have other options. If your periods are very heavy or last a long time, your doctor may prescribe hormone replacement therapy. Medication does not work for all women but is an option for some. Another alternative to surgery is endometrial ablation, which can be performed in the office. Endometrial ablation is a medical procedure that removes the lining of the uterus, called the endometrium. After endometrial ablation, you may no longer have any bleeding, but a percentage of women do continue to experience lighter menstrual cycles.

Know Your Options
Your doctor or surgeon will help you determine what treatment is best for you. Refer to the Questions to Ask Your Doctor section for a list of questions to help guide you through your discussion with your health care provider. 

References:

Sources

http://www.hystersisters.com/

http://www.womenshealth.gov/

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