Hysterectomy surgery involves either making an incision in the abdomen to remove the uterus or removing it through the vagina. The method used to perform the procedure is determined by the surgeon, based on individual situations. There are three basic types of incisions and procedures: TAH or total abdominal hysterectomy, LH or laparoscopic hysterectomy, and VH or vaginal hysterectomy.
Total Abdominal Hysterectomy
During abdominal hysterectomy surgery, the uterus is removed through a surgical incision about 6 to 8 inches long in the abdomen. A total hysterectomy means that the uterus and cervix are removed. A partial hysterectomy involves removing the uterus but not the cervix. When the ovaries and fallopian tubes are removed during a total hysterectomy, it is called a salpingo-oophorectomy.
TAH is most commonly performed when the uterus is enlarged, or when the surgeon must remove other tissue in the pelvic cavity or the fallopian tubes and ovaries. TAH is necessary when the surgeon needs a full view of the abdominal cavity to remove large fibroids or if there is a lot of scar tissue from previous surgeries. According to the Ohio State University Medical Center, the main surgical incision is done one of two ways: vertically, from the navel to the pubic bone, or horizontally, along the top of the pubic hairline.
Laparoscopic Hysterectomy
Another type of incision is made with a laparoscope, a tiny tube with a very small video camera on the end. Laparoscopy is often used when a large abdominal incision is not necessary. Usually three small incisions are made in the abdomen near the navel. Other tubes are inserted through the incisions and the uterus is removed in sections through the laparoscope or through the vagina. Absorbable stitches are used inside the pelvis. Since the incisions are smaller, recovery time is usually quicker and less painful.
Vaginal Hysterectomy
The uterus is removed through the vaginal opening during a vaginal hysterectomy. No external incision is made and there are no visible scars. Vaginal hysterectomy is used when the surgeon feels the uterus can be removed without having to make any type of incision in the abdomen for access. "The New Harvard Guide to Women's Health" states that vaginal hysterectomy is usually less painful, and has less bleeding and less complications than abdominal surgery. Vaginal hysterectomy usually has a shorter recovery time as well.
References
- Ohio State University Medical Center: Hysterectomy
- "The New Harvard Guide to Women's Health"; Carlson, Eisenstat and Ziporyn, 2004
- Deborah Wilson, MD: Laparoscopic Hysterectomy
