Hysterectomy - Comparison of Hysterectomy Procedures
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:
- To remove small
- When the
uterus is of normal size or slightly enlarged.
endometriosis growths (implants) are not
- When there is no significant scarring in the pelvis from previous surgeries.
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:
- The uterus is very large.
fibroids are larger than
8 in. (20 cm) across or located
around blood vessels.
- Cancer of the uterus, ovaries, or
cervix is possible.
- An ovarian growth (mass) is suspected but can't be diagnosed on
- There is significant scarring or severe endometriosis
in the pelvic area.
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:
- When uterine fibroids are small to moderate
- When the uterus is slightly larger than normal.
- To remove endometriosis and scar tissue (adhesions)
confined to the uterus,
fallopian tubes, and
- To assess or remove ovaries at
the same time as a vaginal hysterectomy.
LAVH requires the surgeon to have
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:
- To remove uterine fibroids of any
- To remove a uterus of any size.
LSH usually takes longer to do than abdominal or vaginal hysterectomy. LSH is
not available in some areas.