This article will hopefully explain to patients the different ways a hysterectomy can be performed by the gynecologist. I have been performing hysterectomies as well as laparoscopies for 36 years in private practice and this operation is the ultimate melding of the two procedures. Hysterectomies have been performed for many decades, mostly abdominally and vaginally. I was trained back in the 1970’s, but over the last few years, the laparoscopic approach added more choices for the surgeon and the patient. The different types of hysterectomies (with or without the removal of the ovaries) being done today are as follows:
Total Abdominal Hysterectomy: This type of hysterectomy is performed with a large incision, laparotomy with usually a 2-3 day stay in the hospital.
Total Vaginal Hysterectomy (VH): This type of hysterectomy is performed completely vaginally with no visible incisions and requires a 1-2 day stay. It is considered one of the minimally invasive hysterectomies.
Laparoscopic Assisted Vaginal Hysterectomy (LAVH): This hysterectomy is performed vaginally with laparoscopic assistance and usually requires a 2 day stay. This procedure is minimally invasive surgery. This surgical procedure designed initially to convert a difficult hysterectomy perhaps done abdominally into a safer and easier vaginal hysterectomy. Most of the operation is done initially through the laparoscope down to the cervix and then the rest of the operation completed vaginally. I performed this operation for many years before advancing on to total laparoscopic procedures below.
Laparoscopic Supracervical Hysterectomy (LSH or LSCH): This hysterectomy is performed laparoscopically only with just the removal of the body of the uterus and leaving the cervix behind. It is minimally invasive surgery. The uterus is morcellated through the laparoscope or can be pulled out through an abdominal incision. Unfortunately, the FDA has placed a warning on the use of the morcellator, so this operation has not been performed very much lately.
Total Laparoscopic Hysterectomy (TLH or LTH)
Straight Stick: This hysterectomy involves the complete removal of the uterus via laparoscopic surgery. The hospital stay is one night. All of the surgery is done laparoscopically with the surgeon manually manipulating the laparoscopic instruments while standing at the operating table. This procedure is considered a minimally invasive hysterectomy, TLH or LTH. It is one of the newest and ultimate ways to perform a total hysterectomy with shorter hospital stay and return to normal activity. It required my extending my training further up the ladder to be able to perform this operation. I performed these for a few years until moving on to the next procedure. I still perform some of these.
Robotic Assisted or da Vinci Total Laparoscopic Hysterectomy: This procedure of hysterectomy is the one I mostly do today. It required further training for me, going beyond my experience doing “straight stick” total laparoscopic hysterectomies. This procedure has become the ultimate procedure of hysterectomy for me and some gynecologic surgeons. It requires a one night stay in hospital and uses very small laparoscopic incisions. I like this procedure for a lot of reasons, but the main one is that I get to operate in 3D and see the operating field some much clearer.
I will close this article by adding one other little new addition to the hysterectomy. Most of the gynecologists are now removing the tubes completely with the knowledge that perhaps as many as 70% of the ovarian cancers may originate in the distal tube. Also, the type of hysterectomy to be performed depends on many variables including the patient’s physical findings and desires as well as the doctor’s training and recommendations for what’s best and safest for the patient. Not all patients are good candidates for vaginal hysterectomy, LAVH, LSCH, or TLH. I hope this has been informative.
JimMcBride, MD