Types of Hysterectomy
All hysterectomies include removal of the uterus, but the type of procedure used often depends on the condition being treated:
- In partial or supracervical hysterectomy, the upper portion of the uterus is removed, leaving the cervix intact.
- Complete or total hysterectomy involves the removal of both the uterus and the cervix. This is the most common type of hysterectomy performed.
- Hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes, and ovaries.
- Radical hysterectomy is an extensive surgical procedure in which the uterus, cervix, ovaries, fallopian tubes, upper vagina, some surrounding tissue, and lymph nodes are removed.
Hysterectomy Surgical Procedures
Traditionally, hysterectomies have been performed using a technique known as total abdominal hysterectomy (TAH). However, in recent years, two less-invasive procedures have been developed: vaginal hysterectomy and laparoscopic hysterectomy.
In a total abdominal hysterectomy (TAH), the surgeon makes an incision approximately five inches long in the abdominal wall, cutting though skin and connective tissue to reach the uterus. The cut can be either vertical3running from just below the navel to just above the pubic bone, or horizontal—running across the top of the public bone (known as a bikini-line incision).
One advantage of total abdominal hysterectomy is that the surgeon can get a complete, unobstructed look at the uterus and surrounding area. There is also more room in which to perform the procedure. This type of surgery is especially useful if there are large fibroids or if cancer is suspected. Disadvantages include more pain and a longer recovery time than other procedures, and a larger scar.
A vaginal hysterectomy is done through a small incision at the top of the vagina. Through the incision, the uterus (and cervix, if necessary) is separated from its connecting tissue and blood supply and removed through the vagina. If the cervix is not being removed, the incision is made around the cervix, which is then reattached when the surgery is finished.
This procedure is often used for conditions such as uterine prolapse. However, the surgeon has less room in which to operate and is not able to observe other organs in the pelvic region. Vaginal hysterectomy heals faster than abdominal hysterectomy, results in less pain, and generally does not cause external scarring.
In laparoscopic hysterectomy, special surgical tools are used to operate through small incisions in the abdomen and vagina. There are two types of laparoscopic hysterectomy: laparoscopically assisted vaginal hysterectomy (LAVH) and laparoscopic supracervical hysterectomy (LSH).
LAVH is similar to vaginal hysterectomy, and the uterus and cervix are removed through an incision at the top of the vagina; however, the surgeon also uses a laparoscope (miniature camera) inserted into the abdomen to see the uterus and surrounding organs. Other laparoscopic tools are inserted into abdominal incisions to detach the uterus before removing it.
LSH is performed entirely through small abdominal incisions, using laparoscopic tools to remove just the uterus. Since the cervix is not removed, the uterus is detached and removed in small pieces through the incisions. No incision is made at the top of the vagina.
Both types of laparoscopic hysterectomy cause less pain and have faster recovery times than TAH and produce minimal scarring.