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Hysterectomy - Comparison of Hysterectomy Procedures

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 size.
  • 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.

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:

  • To remove uterine fibroids that are small to moderate in size.
  • When there is not a lot of scar tissue in the pelvic area.
  • When there is not a worry about cancer in the ovaries.

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.

Some laparoscopic surgery is done using only one incision. This is called laparoendoscopic single-site surgery (LESS) or single-port surgery.

Some doctors offer robot-assisted surgery for hysterectomy. For this method, the surgeon controls robotic arms that hold the surgery scope and tools. Robotic surgery for hysterectomy may be an option for women who have certain conditions. But it usually costs more money, and studies have not shown that it is better than other hysterectomy procedures.2

Advantages and disadvantages of hysterectomy procedures
Procedure Advantages Disadvantages
Vaginal hysterectomy
  • Enables removal of a normal to slightly larger-than-normal uterus and small uterine fibroids
  • When compared with abdominal hysterectomy, requires a shorter hospital stay3
  • Usually has a faster recovery than an abdominal hysterectomy3
  • Tends to cause less pain during recovery than after an abdominal surgery
  • Doesn't leave scars on the abdomen

When compared with abdominal hysterectomy, a routine vaginal hysterectomy:

  • Doesn't allow free access to the pelvic organs. The doctor may not be able to remove a very large uterus; large fibroids; areas of endometriosis, adenomyosis, or scar tissue (adhesions).
  • Isn't used for cancer-related surgery.
  • May need to be switched to an abdominal surgery if the doctor is unable to remove a very large uterus or areas of endometriosis, adenomyosis, or scar tissue (adhesions).
Abdominal hysterectomy
  • Provides the surgeon good visibility and easy access to the pelvic organs
  • Enables removal of a very large uterus or large areas of endometriosis, adenomyosis, or scar tissue (adhesions)
  • Cervix can be removed or left in place
  • Requires less time under anesthesia and in surgery than a laparoscopic hysterectomy4

When compared with other types of hysterectomy, a routine abdominal hysterectomy:

  • Requires longer hospital stay and recovery time.3
  • Tends to lead to more pain during recovery.
  • Leaves a visible scar on the abdomen. A bikini-line incision may be possible.
Laparoscopically assisted vaginal hysterectomy (LAVH)
  • Allows your doctor to examine your pelvic organs camera.gif and remove cysts, scar tissue (adhesions), fibroids, and areas of infection
  • When compared with abdominal hysterectomy, requires a shorter hospital stay and causes less pain during recovery3
  • Smaller scars on the abdomen than with an abdominal hysterectomy

When compared with other types of hysterectomy, a routine LAVH:

  • May need to be switched to an abdominal surgery if the doctor is unable to remove a very large uterus or areas of endometriosis, adenomyosis, or scar tissue (adhesions).
  • Takes more time to perform.3
  • May have an increased risk of injury if the surgeon is inexperienced.
Laparoscopic supracervical hysterectomy (LSH)
  • When compared with abdominal hysterectomy, requires a shorter hospital stay, with a faster and less painful recovery
  • Leaves smaller scars on the abdomen than with an abdominal hysterectomy

When compared with other types of hysterectomy, a routine LSH:

  • May need to be switched to an abdominal surgery if the doctor is unable to remove a very large uterus or areas of endometriosis, adenomyosis, or scar tissue (adhesions).
  • Is likely to cost more.
  • May have an increased risk of injury if the surgeon is inexperienced.
Total laparoscopic hysterectomy (TLH)
  • Does not use an incision in the wall of the vagina
  • When compared with abdominal hysterectomy, requires a shorter hospital stay, with a faster and less painful recovery
  • Leaves smaller scars on the abdomen than with an abdominal hysterectomy

When compared with other types of hysterectomy, a routine TLH:

  • May need to be switched to an abdominal surgery if the doctor is unable to remove a very large uterus or areas of endometriosis, adenomyosis, or scar tissue (adhesions).
  • Is likely to cost more.

This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http:// cancer .gov or call 1-800-4-CANCER.

WebMD Medical Reference from Healthwise

Last Updated: March 12, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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