Types of Hysterectomy

What is Hysterectomy?

Hysterectomy involves removal of a woman's uterus and perhaps more of a woman's reproductive organs, terminating her ability to have children. The National Women's Health Information Center of the Department of Health and Social Services uses the following definitions for the types of hysterectomy surgery. A complete or total hysterectomy removes the cervix and uterus and is the most common type. A partial or subtotal, also known as a supracervical hysterectomy removes the upper part of the uterus and leaves the cervix in place. A radical hysterectomy removes the uterus, cervix, upper vagina and supporting tissues. This type of surgery may be performed for some cases of cancer. Often one or both ovaries and fallopian tubes are removed at the time of the hysterectomy. If both ovaries and fallopian tubes are removed it is known as a bilateral salpingo-oophorectomy.

Types of Surgery

There are three types of hysterectomy surgery. The type of surgery used is determined by the reason for the surgery, uterine size, scar tissue, and general health.

Vaginal hysterectomy

Vaginal hysterectomy is surgical removal of the uterus through an incision in the vagina. The ovaries and other organs may also be removed. Whenever possible, vaginal hysterectomy is generally the best approach. Vaginal hysterectomy is not appropriate for cancer of the ovaries or extensive cancer of the cervix.

The advantages of vaginal hysterectomy include shorter hospital stay and recovery time, less pain, lower cost, and no abdomen scars.

Disadvantages to consider are:

• Possible shortenting of vagina length, which may cause painful intercourse in the first months after surgery.
• Difficulty in removing a large uterus or large fibroids and areas of endometriosis and adenomyosis.
• Less operating space makes it difficult for the surgeon to see other pelvic organs.

Laparoscopically assisted vaginal hysterectomy (LAVH)

Laparoscopically assisted vaginal hysterectomy (LAVH) is a surgical procedure using a viewing tube (laparoscope) through which structures within the abdomen and pelvis can be seen. A small surgical incision is made in the abdominal wall to permit the laparoscope to enter the abdomen or pelvis.

A laparoscopically assisted vaginal hysterectomy (LAVH) offers a combination of the advantages and disadvantages of vaginal and abdominal hysterectomy. With LAVH, the doctor is better able to examine pelvic organs and remove cysts, scar tissue, fibroids, and areas of infection than with a vaginal hysterectomy, generally with smaller abdomen scars, less pain, less cost, and shorter hospital stays than with abdominal hysterectomy. The possibility still remains however that the doctor will not be able to remove a very large uterus, and areas of endometriosis, adenomyosis, and scar tissue. Injury to the bladder is also possible.

Abdominal hysterectomy

An abdominal hysterectomy removes the uterus and other pelvic organs through an incision in the abdomen. Abdominal hysterectomy allows the surgeon to easily see pelvic organs so it is usually done when cancer of the uterus, ovaries, or cervix is suspected, when there is significant scarring, or when the uterus is very large. The disadvantages of abdominal hysterectomy are that the surgery usually takes longer with a longer time under anesthesia, the hospital stay and recovery time are no longer with more pain, costs are greater, and there is a visible scar on the abdomen.