Laparoscopic Hysterectomy is a minimally invasive choice
- Innovative, minimally invasive procedure
- Designed to reduce pain
- Leaves only tiny scars
- You can be home resting comfortably within 24 hours.
- You can get back to most of your routine in one to two weeks
The decision to have a hysterectomy is rarely an easy one.
After all, a hysterectomy is major surgery, and that by itself can be scary. You probably have questions about how a hysterectomy will make you feel physically, emotionally and even sexually, long after the surgery is over.
Chances are you’ve talked about the issues that are most important to you with your doctor, family, and friends. You’ve explored the alternatives. But now that you and your doctor have concluded that a hysterectomy is the best option, where do you go from here?
Even after the decision to have a hysterectomy is made, you still have options to consider and choices to make. The days when every woman had the same kind of hysterectomy are long gone. Today there are several types of hysterectomies including minimally invasive procedures.
A quick guide to the female reproductive system.
Also known as the womb. It is the muscular, pear-shaped female reproductive organ inside which a fertilized egg is implanted and a developing embryo and fetus grows.
The 2 female reproductive glands in which eggs are formed and which produce the essential female hormones estrogen and progesterone. They are located in the lower abdomen, to the left and right of the uterus.
The organ through which blood and tissues pass out of the body during menstrual periods and through which a baby passes during birth. Fallopian tubes- Two thin tubes through which the egg (fertilized or not) travels from the ovaries to the uterus.
The mucous membrane that lines the inner surface of the uterus, and which thickens during each menstrual cycle to prepare the uterus from implantation of a fertilized egg. Most of the endometrium is shed with each menstrual flow if fertilization does not occur.
The lower, narrow part below the uterus- it connects the uterus to the vagina. The cervix dilates with labor to allow the baby to pass.
What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus, or womb. It is the second most frequently performed surgery on women after Cesarean section (C-section). Depending on the type of hysterectomy performed and the reason it’s being done, removal of the cervix, ovaries and fallopian tubes is sometimes performed during the same surgery.
There are 2 basic types:
Supracervical (subtotal or partial) Hysterectomy
The uterus is removed but the cervix is left in place, which some research suggests may help to reduce the risk of pelvic floor prolapse. It may also help preserve sexual function. Moreover, recovery is easier. The ovaries and fallopian tubes may or may not be removed.
Total Hysterectomy (or “Traditional Hysterectomy”)
The uterus and cervix are removed. As an option the ovaries and fallopian tubes may or may not be removed.
Why are hysterectomies sometimes necessary?
Each year, 600,000 women in the United States undergo hysterectomies to treat a range of conditions. These include:
Usually benign (non-cancerous) growths inside the uterus. A fibroid can be as small as a pea or grow larger than a grapefruit.
The medical term for excessive menstrual bleeding. Menorrhagia is usually caused by hormonal changes or by fibroids. It can also be caused by infection or disease.
A condition where tissue that normally resides in the uterus appears in other parts of the abdomen. It can cause pelvic pain and infertility
Pelvic Support Problems
A condition such as uterine prolapse, when the uterus falls from its normal position and descends into the vagina.
Some Issues to Consider…
You should discuss your goals for treatment and recovery with your doctor. Some of the factors you’ll want to consider include whether the cervix, ovaries, or fallopian tubes will need to be surgically removed during the procedure and which procedure is the least invasive.
What are the benefits of keeping my cervix?
The cervix connects the upper portion of the vagina to the uterus. The ligament attached to the cervix provides support for both organs. For this reason, some gynecologists feel that leaving the cervix in place is important to reduce the chance of pelvic floor support problems. In addition, some research suggests the cervix may play a role in sexual arousal and the ability to achieve organism in some women.
On the other hand, retaining the cervix, means you may still experience some periodic bleeding. In addition, you – like women who have not had a hysterectomy- should continue to have pap smears to screen for cervical cancer.
What happens if my ovaries are removed?
If your ovaries are removed, you will enter menopause, if you have not done so already. Therefore, you may experience the symptoms associated with menopause (such as hot flashes, insomnia, vaginal dryness, irritability or depression). This may be helped with estrogen replacement therapy.
Exploring Your Options…
It used to be that total abdominal hysterectomy (removal of the uterus and cervix through a large abdominal incision) was often the only type of hysterectomy offered to women. If the uterus was small and dropping in the vaginal canal, a vaginal hysterectomy could also be performed. But today, the development of improved surgical devices and innovative techniques allows for less invasive procedures that can remove the uterus but can sometimes allow you to keep your cervix. Hospital stays and recovery times have also been reduced.
Although some medical conditions may require specific techniques, it is important to know what your options are and to discuss them with your doctor.
What are the different ways to perform a hysterectomy?
Laparoscopic supracervical hysterectomy (LSH)
Is an option that uses laparoscopy alone to remove the uterus, but leaves the cervix intact. During the procedure, a laparoscope and small surgical instruments are inserted through tiny incisions in the navel and abdomen. Using these instruments, the surgeon is able to carefully separate the uterus from its pelvic connections and from the cervix. The uterus is then removed through one of the incisions.
LSH is less invasive than traditional “open” hysterectomy and has many advantages. It was developed to reduce pain and trauma to the body, minimize scarring, and shorten recovery time. The procedure can be performed on an inpatient or outpatient basis, which means that you can be home resting comfortably within 24 hours, and back to your normal activities in one to two weeks.
In addition, LSH preserves the cervix, which some research suggests may help to reduce the risk of pelvic floor prolapse, and other complications associated with total hysterectomies, including sexuality concerns.
Total Laparoscopic Hysterectomy (TLH)
Is very similar to the LSH except the cervix is removed along with the uterus. Oftentimes the organs are removed through the vagina. Like LSH, TLH is less invasive than traditional “open” hysterectomy. You will usually be out of the hospital within 24 hours and recovery takes about 2 weeks. This is technically the most difficult type of the hysterectomy to perform, so it should be done by a highly skilled laparoscopic surgeon.
Total Abdominal, or open, hysterectomy (the “traditional” hysterectomy)
Involves removal of the uterus and cervix (with or without removal of the ovaries or fallopian tubes) through a large abdominal incision. This is the most invasive type of hysterectomy, and also the most common. Total abdominal hysterectomy may be recommended if you have large fibroids that have not responded to hormone therapy or would be difficult to remove vaginally. It also may be the preferred procedure if you have severe endometriosis (uterine lining tissue that has found its way out of the uterus), prior pelvic infections, scarring from prior pelvic surgeries, or some types of cancer.
Total abdominal hysterectomy requires an average hospital stay of 2 days and a recovery period up to 6 weeks.
Is a procedure that removes the uterus and cervix through an incision inside the vagina. Tubes and ovaries can often be removed at the time of vaginal hysterectomy. This is the method commonly chosen to treat uterine-vaginal prolapse and can also be used to help treat early cervical or uterine cancer.
A vaginal hysterectomy usually results in less postoperative discomfort than you would feel after a total abdominal hysterectomy. It has a hospital stay of 1-2 days and a recovery time of 2-4 weeks. There is no visible scarring. Vaginal hysterectomy may not be appropriate if very large fibroids are present.
Assisted vaginal hysterectomy (LAVH) is similar to a vaginal hysterectomy-the uterus and cervix are removed through an incision inside the vagina-but also includes the use of a laparoscope (a thin, lighted telescope) which is inserted through a tiny incision in the navel and abdomen.
Use of a laparoscope allows the upper abdomen to be carefully inspected during surgery and allows the surgeon to perform part of the surgery through incisions leaving small scars. Tubes and ovaries may be removed if needed by this technique. Hospital stay and recovery time are similar to simple vaginal hysterectomy. The combination of vaginal hysterectomy with laparoscopic technique requires more skill to perform and more time in the operating room than total abdominal or vaginal hysterectomy procedures along.
Some Final Thoughts…
The decision about which kind of hysterectomy to have is an important one. Remember, it’s usually an elective procedure, not an emergency. Give yourself some time to thoroughly understand your options. Talk with your doctor.