Hysterectomy

Gynecologists at Greenville Health System (GHS) are experienced in minimally invasive approaches to hysterectomy as well as procedures that provide relief from symptoms that in the past would have required the operation.

There are two traditional types of hysterectomy: abdominal and vaginal. With vaginal hysterectomy, the surgeon makes an incision at the top of the vagina and removes the uterus through it. DaVinci robotic surgery is also an increasingly popular choice due to its minimally invasive nature and quick recovery time. To learn more about robotic surgery for women, click here.

“Vaginal hysterectomy tends to be many physicians’ first choice because there is no incision needed on the outside of the body, and there’s a quick recovery time,” said Laura Wang, M.D., FACOG, a gynecologist with Gynecology Specialists. “But some women are not candidates for it.” Some conditions that preclude vaginal hysterectomy include an enlarged uterus (often the result of fibroids), previous operations, history of severe endometriosis with adhesive disease, small pelvis, a malignant or premalignant condition or simply the need for better exposure to the abdomen.

For many years, patients who were not vaginal hysterectomy candidates had no choice but abdominal hysterectomy. This procedure requires not only a six-inch incision through the abdominal wall but also a typical hospital stay of three days and postoperative recovery period of four to six weeks.

Today there are more options. “Laparoscopic surgery is a minimally invasive alternative for a growing number of women,” said Dr. Wang.

Laparoscopic hysterectomy requires only a small incision near the navel for the insertion of a laparoscope and then other quarter-inch incisions (ports) in the abdomen for other surgical instruments. Benefits include less bleeding and scarring, reduced pain and much shorter hospital stay and decreased recovery time compared with abdominal hysterectomy.

Innovative surgical instruments play an important role. Some surgeons use harmonic scalpels, for example, to detach the uterus from surrounding tissue. Instead of cutting and burning tissue as electrosurgical instruments do, harmonic scalpels use high-frequency sound waves and may offer greater precision in tight spaces. Another critical instrument, called a morcellator, separates the uterus into strips of tissue narrow enough to be removed through tiny incisions.

Three Laparoscopic Approaches

Total laparoscopic hysterectomy (TLH).

This procedure involves removing the entire uterus, including the cervix, through the vagina. The top of the vaginal opening inside the abdomen is then sewn together using instruments inserted through the laparoscope.

Laparoscopically assisted vaginal hysterectomy.

In this operation, the surgeon inserts a laparoscope through the abdomen to inspect the upper abdomen extensively during the procedure. A surgeon might opt for this approach if the patient has pelvic adhesive disease that may have rendered a straightforward vaginal approach unsafe. This technique also may be preferred if the surgeon plans to remove the ovaries. During the procedure, the surgeon uses port access to disconnect the uterus and other structures, which then are removed through the vagina.

Laparoscopic supracervical hysterectomy (LSH).

This less- invasive approach is preferred by surgeons who believe it may be associated with a decrease in future incidence of vaginal prolapse. The surgeon detaches the uterus from the cervix but leaves the cervix and its fibrous support structures intact. The uterus is cut into small strips, which then are pulled out through ports.

After this operation, both cervical dysplasia (precancerous changes of the cervix) and cervical cancer remain a possibility, so routine Pap test screening should continue.

GHS surgeons also perform many procedures that offer alternatives to hysterectomy surgery.