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Comparison of Hysterectomy Procedures
There are several different hysterectomy procedures, each with advantages and disadvantages. Depending on your reason for considering a hysterectomy, you may have a choice between two or more procedures. For complicated or cancer-related conditions that require maximum access and careful examination, your doctor will likely recommend an abdominal hysterectomy.
This type of hysterectomy is done through a small incision in the vagina, rather than through an abdominal incision. The ovaries and other organs may also be removed. Vaginal hysterectomy tends to cause less pain, and takes less healing time than abdominal hysterectomy. A vaginal hysterectomy can be done:
Vaginal hysterectomy requires more specialized surgical skill than an abdominal hysterectomy. It can pose a higher risk of injury to other organs. Vaginal hysterectomy is not used when there is a question about possible cancer in the uterus, cervix, or ovaries.
This type of hysterectomy is done through a larger abdominal incision, giving the surgeon the best possible access to the pelvic organs. The cervix may be removed with the uterus (total hysterectomy) or left in place (subtotal hysterectomy). The ovaries and other organs may also be removed. An abdominal hysterectomy is typically done when:
If a hysterectomy is chosen to treat endometriosis, an abdominal hysterectomy is usually required. One example is when endometriosis growths (implants) or scar tissue (adhesions) must be removed to restore the function of other organs.
Laparoscopically assisted vaginal hysterectomy (LAVH)
Laparoscopic hysterectomy is done with a viewing instrument (laparoscope) and surgical instruments inserted through a vaginal incision and one or more small abdominal incisions. The ovaries and other organs may also be removed. The uterus is removed through the vagina. It is done:
LAVH requires the surgeon to have specialized training.
Laparoscopic supracervical hysterectomy (LSH)
Laparoscopic supracervical hysterectomy is done by inserting a laparoscope and surgical instruments through several small abdominal incisions. The uterus is removed in small pieces through one of the incisions and the cervix is left intact. This is also known as subtotal or partial hysterectomy. This type of procedure usually causes minimal blood loss and pain. The hospital stay is shorter than for total abdominal surgery. Most women can return to normal activity a week or two afterward. LSH can be done:
LSH usually takes longer to do than abdominal or vaginal hysterectomy. LSH is not available in some areas.
Total laparoscopic hysterectomy (TLH)
The total laparoscopic hysterectomy is done by inserting a laparoscope and surgical instruments through several small incisions in the abdomen. The uterus and the cervix are removed in small pieces through one of the incisions. TLH can be done:
TLH requires the surgeon to have special training. It usually takes longer to do than abdominal or vaginal hysterectomy. But recovery and hospital stay are shorter than for total abdominal hysterectomy. TLH is not available in many parts of the country.
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