Laparoscopic Hysterectomy
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The surgical procedure to remove a woman’s uterus (also known
as the womb) is called hysterectomy. It is the second-mostcommon
surgery among women in the United States, topped
only by Caesarean-section (C-section) surgery to deliver babies.
Sometimes other reproductive organs are removed at the
same time as the hysterectomy. When the cervix is removed
along with the uterus, the procedure is called a “complete”
or “total” hysterectomy.
If only the upper part of the uterus is removed, leaving the
cervix in place, the procedure is called a “partial,” “subtotal”
or “supracervical” (pronounced “soop-ruh-SER-vuh-kul”) hysterectomy.
(This is the type of hysterectomy described in the
accompanying article.)
Another procedure, called a “radical” hysterectomy, removes
the uterus and cervix, as well as the upper part of the vagina
and supporting tissues. This surgery is often performed when
certain types of cancer are present.
In many cases, one or both of a woman’s ovaries and
fallopian tubes are also removed during the hysterectomy.
When both ovaries and both tubes are removed, it is called
a “bilateral salpingo-oophorectomy.”
What Is a Hysterectomy?
For more information about hysterectomy, as well as a wide
variety of other women’s health topics, visit these Web sites:
Learn More About Hysterectomy
and Women’s Health
Thousands of hysterectomies are performed every year
for a variety of reasons. Abnormal bleeding, fibroids,
pelvic pain and fallen uterus are the most common
reasons women seek removal of their uterus.
Hysterectomy is an ideal option if more conservative, less
invasive, options have failed and the patient has no desire to
bear more children. The conventional hysterectomy involves
a skin incision, either along bikini line or up and down, to reach
the uterus and other pelvic structures. Tissues are clamped,
cut and removed, then the incision is closed with sutures or
staples, or it is glued and taped shut.
The hospital stay with this approach is typically two to
four days after surgery, and recovery takes six to eight weeks.
In this time, the patient may experience significant discomfort
and pain in the area of the incision.
With the cervix removed, there is a large opening at the
top of the vagina that is sutured shut. Healing of the vagina
produces a discharge and some light bleeding, and the patient
should not have sex for six weeks.
Faster Recovery, Less Pain
A newer technique developed over the past few years has minimized
the trauma and healing time of hysterectomies. This
technique, called laparoscopic hysterectomy, is made possible
by a device called a laparoscope, which allows the surgeon to
view the inside of the abdomen via small abdominal incisions.
Images from inside the abdomen are projected through a TV
monitor in the surgical suite.
Under direct view, the tissues surrounding the uterus can be
cauterized and cut without the use of sutures. Typically, this surgery
is completed by the surgeon removing the cervix and uterus
through the vagina, which gives the technique its other common
name: laparoscopically assisted vaginal hysterectomy (LAVH).
Laparoscopic hysterectomy still leaves an opening at the top
of the vagina that needs to be closed. So although the discharge
and bleeding are the same as with the conventional surgery,
pain is generally less, the hospital stay is shorter and recovery
is faster.
An Improvement on the Improvement
A recently introduced invention called a morcellator enables
surgeons to remove the uterus, and even the ovaries, without
having to make large abdominal incisions. In this newest technique,
the uterus is cut away from the cervix and the cervix
stays in place, eliminating the opening at the top of the vagina
that occurs with other hysterectomy techniques. After the uterus
and cervix are separated, the uterus is morcellated, or made
into little pieces that can easily be removed.
Compared to open surgery, this laparoscopic approach
results in a shorter hospital stay, faster recovery, smaller visible
scars, less internal scarring, less pain and a lower complication
rate when performed by an experienced surgeon. The
surgery can be completed in less than an hour, and the hospital
stay is rarely more than overnight. Since the cervix remains
with this procedure, regular Pap tests are recommended.
Additional Reading:
 Laparoscopically Assisted Vaginal Hysterectomy
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