Hysterectomy Procedures
Physicians perform hysterectomy – the surgical removal of the uterus – to treat a wide variety of uterine conditions.
Types of Hysterectomy
There are various types of hysterectomy that are performed depending on the patient’s diagnosis. All hysterectomies involve removal of the uterus. What can vary are which additional reproductive organs and other tissues that may be removed. Types of hysterectomy include:
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Partial or subtotal hysterectomy: This is also known as a supracervical hysterectomy. This procedure involves removing the uterus, but leaves the cervix intact. This decision is often based upon patient preference. Some women feel that leaving the cervix intact will preserve sexual function following surgery.
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Total hysterectomy: This procedure involves removing the uterus and the cervix. The vagina remains entirely intact. This is the most common type of hysterectomy performed.
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Removal of lymph nodes: For hysterectomies performed for malignant conditions – such as uterine, cervical, or ovarian cancer – the surgeon will also remove certain lymph nodes. This procedure is often referred to as a lymph node dissection or lymphadenectomy. Lymph nodes will be removed in certain areas, depending upon the location and extent of the disease. Lymph node removal also helps your surgeon determine the extent or stage of your cancer, and can guide further adjuvant treatment, such as radiation therapy or chemotherapy.
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Removal of the fallopian tubes and ovaries: These organs may or may not be removed during your hysterectomy procedure. This will depend upon your condition, age, and other factors. Often, the ovaries and fallopian tubes are left intact. Removal of the ovaries is called an oophorectomy. Removal of fallopian tubes and ovaries is called a salpingo-oophorectomy.
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Radical hysterectomy: Removes the uterus and cervix
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Total hysterectomy: This procedure is most often performed for cervical cancer, and involves removal of the uterus, tissues next to the uterus, the upper part (about 1 inch) of the vagina and pelvic lymph nodes. The fallopian tubes and ovaries may also be removed.
Approaches to Hysterectomy
Open Approach
Surgeons perform the majority of hysterectomies using an “open” approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6-12 inch incision.
Vaginal Approach
A second approach is vaginal hysterectomy, which involves the removal of the uterus through the vagina, without any external incision or subsequent scarring. Surgeons most often use this minimally invasive approach if the patient’s condition is benign, when the uterus is normal size and the condition is limited to the uterus.
Laparoscopic Approach
In laparoscopic hysterectomies, the uterus is removed using instruments inserted through small tubes into the abdomen, resulting in 3-5 small incisions in the abdomen. One of these instruments is an endoscope – a small miniaturized camera – which allows the surgeon to see the target anatomy on a standard 2D video monitor. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy.
Dr. Adcock performs advanced surgical procedures utilizing single-port technologies.
The latest advancement in laparoscopic surgery, a hysterectomy performed using the Single Port allows for the removal of the uterus through a small incision made in the belly button which measures 20 mm, or slightly smaller than the diameter of a nickel. To perform this procedure, the surgeon will insert into the belly button a special Single Port, a soft and flexible instrument equipped with three distinct openings which allows for the use of three surgical devices at the same time. When the surgery is complete, the Single Port is removed from the belly button, leaving one incision which may not be visible upon healing. Recovery from the Single Port hysterectomy may be similar to the 2 week recovery time associated with laparoscopic hysterectomy; however, laparoscopic hysterectomies may require multiple incisions.
Hysterectomy Abbreviations
You may encounter shorthand abbreviations describing different approaches to hysterectomy. Some of these are as follows:
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Total Laparoscopic Hysterectomy (TLH): The uterus and cervix are removed using laparoscopic instrumentation through 3-5 small incisions made in the abdomen.
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Laparoscopic Supracervical Hysterectomy (LSH): The uterus is removed, but the cervix is left in tact, using laparoscopic instrumentation through 3-5 small incisions made in the abdomen. The uterus is removed through one of the small incisions using an instrument called a morcellator.
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Total Vaginal Hysterectomy (TVH): The uterus and cervix are removed through an incision deep inside the vagina. This is often the surgical approach to treat uterine prolapse.
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Total Abdominal Hysterectomy (TAH): The uterus and cervix are removed through a large abdominal incision. The incision size can vary from 6-12 inches, depending upon the patient’s condition.
While minimally invasive vaginal and laparoscopic hysterectomies offer important potential advantages to patients over open abdominal hysterectomy – including reduced risk for complications, a shorter hospitalization and faster recovery – there are inherent drawbacks. With vaginal hysterectomy, surgeons are challenged by a small working space and lack of view to the pelvic organs. Additional conditions can make the vaginal approach difficult, including when the patient has:
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A narrow pubic arch (an area between the hip bones where they come together)
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Thick adhesions due to prior pelvic surgery, such as C-section
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Severe endometriosis
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Non-localized cancer (cancer outside the uterus) requiring more extensive tissue removal, including lymph nodes
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