Arriving at the decision to have a hysterectomy stirs up a lot of emotions—fear, uncertainty and even relief. Over 6,000,000 hysterectomies are performed each year, making it the second most common surgical procedure performed on women in the United States. Major surgery was once the only option, with women decades ago resigning themselves to long hospital stays and months of painful recovery. Today, there are a variety of procedures to consider.
When deciding which is right for you, several factors should be taken into consideration, including the reason for the surgery, whether you have had children, and your age. A qualified surgeon can closely review your conditions with you, helping you to make an informed decision by giving you a full overview and explanation. As you become educated, it is important to advocate for yourself and to choose a health care provider who will advocate for you. Before any type of hysterectomy, your health care provider will perform a pap smear and prepare you for what to expect. This article serves as introduction to the different types of hysterectomy procedures being performed today.
1. Total abdominal hysterectomy
The surgeon will make a four to five inch long incision in the lower abdomen using either a vertical line or a horizontal bikini-line incision. The type of incision will depend upon whether the surgeon needs to explore the upper region of the abdomen, whether you have any prior scar tissue, and the size of your uterus. This procedure is advantageous for a surgeon who is looking for fibroids and other tumors. It takes about two hours and requires a hospital stay. Recovery is reported to be more painful and to take longer than it does for other procedures. This approach also leaves visible scarring, but you can discuss this with your doctor in advance and find ways to minimize scarring through follow-up care.
2. Vaginal hysterectomy
This hysterectomy can be performed under general anesthesia or with a spinal block also referred to as regional anesthesia. The latter allows the patient to remain awake through the procedure. While you lie on your back, your surgeon will place you in a position similar to the one you adopt when undergoing a Pap smear. An incision is made at the top of the vagina, and the uterus is removed through the opening of the vagina using lengthy surgical instruments. There are times the uterus is removed through morcellation, which requires the surgeon to cut the organ into smaller pieces for removal. Women who have never had children are not usually candidates for this procedure. It takes about one to three hours and usually requires a hospital stay. Recovery time is faster than that of an abdominal hysterectomy, and this procedure leaves no visible scarring.
3. Laparoscopic supracervical hysterectomy
This particular laparoscopic surgery is also known as LSH and is performed solely through 3-5 very small incisions in the abdomen (leaving the cervix intact). A surgeon will perform this type of operation utilizing long instruments and a tiny camera. The camera is connected to a monitor in the operation room, helping to guide doctors as they operate. It takes roughly an hour and a half, with quick recovery times and minimal scarring.
4. Robotic hysterectomy
During this type of hysterectomy, a computer (or robot) controls the surgical instruments during the operation. Because the robot’s arms have 360-degree turning capability, a surgeon is able to more precisely control movements and examine smaller spaces in the body. 3D high-definition cameras provide magnified images of tissues, nerves and the uterus for clearer handling during the surgery.
Recent advances in the robotic hysterectomy procedure have even allowed for a single-site procedure utilizing the naval. A port for the robot’s arms is inserted into the belly button, and the entire operation can be performed through just one small incision. While an overnight stay is sometimes required, it can also be performed as an out-patient procedure. Blood loss is minimal, infection risk lessened, pain is minimal, and recovery time is extremely rapid.
Dr. Anupam Garg, San Diego, CA
Scripps Health San Diego