Have you or someone you know, been advised to undergo a hysterectomy? Here’s some information that you should have on the different types of hysterectomy, before you undergo surgery.
Hysterectomy is the surgical removal of the uterus or part of the uterus. In total hysterectomy, along with the uterus, the cervix is also removed. Women cannot conceive once hysterectomy has been performed. It is required to correct one of the following conditions. The most common reason is to remove fibroid tumors that grow in the uterus. The other reasons are abnormal vaginal bleeding, endometriosis, uterine prolapse and cancer of the uterus, ovary or cervix. Let’s take a look at the types of hysterectomies and the different surgical procedures involved.
Types of Hysterectomy
- Total Hysterectomy: It is the most common type, which involves removal of the entire uterus along with the cervix. The ovaries are retained.
- Partial or Subtotal Hysterectomy: The upper part of the uterus is removed, while the cervix may be retained.
- Radical Hysterectomy: The most extensive version of hysterectomy that involves removal of the uterus, ovaries, fallopian tubes, upper part of the vagina, lymph nodes, lymph channels and associated pelvic ligaments.
Hysterectomy Surgical Procedures
In the past, hysterectomy was done by a cut made in the abdomen. However, nowadays it can be performed through the vagina. In vaginal hysterectomy, the recovery is quicker. There are four ways in which hysterectomy can be performed. The method depends on the type of hysterectomy and the reason it is being performed:
Total Abdominal Hysterectomy (TAH)
In abdomninal hysterectomy, an incision of about 4-6 inches is made in the abdomen. It is made either horizontally along the bikini line or vertically in the lower abdomen, from the pubic bone to the navel. The uterus is then removed through this incision. Horizontal cuts leave a less noticeable scar. However, vertical cuts give the surgeons more room to work and better view of the abdominal cavity. The procedure takes between one to three hours. The advantage of this procedure is that it gives view of the entire abdomen and pelvis, this is particularly beneficial in patients with cancer or if the case is not clear. However it is more painful than vaginal hysterectomy. Hospital stay is 5-6 days and recovery period is about 6 weeks.
Vaginal Hysterectomy (VH)
In vaginal hysterectomy, the surgeon makes a cut at the top of the vagina. The uterus is removed through the vagina. It is appropriate when the entire abdominal cavity does not require examination. The patient’s legs will be raised using a stirrup device. It is not convenient for women who have not conceived, as the vaginal canal may be too small. In case the uterus is too large, or the woman cannot have her legs raised in a stirrup device for too long then an abdominal hysterectomy is advised.
It is preferred over a TAH as an abdominal cut is avoided and hence no visible scar. It is also less painful. However, its drawback is that it is difficult for surgeons to see the surrounding tissue and the uterus. This method is not used if ovaries or large fibroids have to be removed. The surgery takes about one to two hours. The patient may be required to stay in the hospital for 1-3 days and the recovery time is usually 4 weeks. A vaginal hysterectomy may be converted to an abdominal hysterectomy, in case there are any complications during surgery.
Laparoscopically Assisted Vaginal Hysterectomy (LAVH)
Laparoscopically assisted hysterectomy combines laparoscopy and hysterectomy. Laparoscope is a small tube which is inserted into the abdomen by making a small incision in the abdominal wall. The laparoscope acts like a telescope. It puts light into the abdomen that helps the surgeons get a continuous view of the area. Laparoscopic tools are used to detach the uterus from ligaments that attach it to other structures in the pelvis.
Similarly, the fallopian tubes and ovaries are detached from their ligaments, if they have to be removed. They are then removed through a cut made in the vagina. The advantages of such a procedure is that incisions made are small and it is less painful. Also, recovery is faster than traditional surgery. Hospital stay is about 1-3 days and recovery time is about 4 weeks. However, it is much more expensive than a vaginal hysterectomy and can be a long operation.
Laparoscopic Supra Cervical Hysterectomy (LSH)
It is the newest procedure of hysterectomy which leaves the woman’s cervix intact. It is referred to as a painless procedure by doctors. In LSH, a laparoscope is inserted through a trocar, which gives the surgeon a magnified view of the internal organs. The uterus is removed through the navel. Ovaries may or may not be removed, but the cervix is retained. Blood loss is lesser than in other procedures. It is preferred over all the other procedures as the patient experiences less discomfort, with no stitches required. Same day surgery is possible and recovery time is the least i.e 2-3 weeks. There are also fewer side-effects and complications involved in this procedure. However, it requires more skill than any other hysterectomy, hence patients should be careful to choose an experienced surgeon.
All hysterectomy surgical procedures involve the patient being admitted in the hospital on the same day as the surgery. The patient’s options for anesthesia are discussed before surgery. Patients must discuss any issues or queries that they have about the procedure, with the surgeon. The duration of hospital stay and recovery depends on the type of surgery. Discuss all options available, before you undergo the surgery.
