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Hysterectomy
Hysterectomy Defined
A hysterectomy is the surgical removal of the uterus, otherwise known as the womb. Rarely is a hysterectomy an emergency surgery. There is usually considerable time to research and explore options for discussions with your personal surgeon. During a hysterectomy the uterus is completely or partially removed. The fallopian tubes and ovaries may also be removed depending on the health needs of the woman
Why have a Hysterectomy?
Hysterectomy is one treatment for a number of diseases and conditions. This operation may save your life if you have cancer of the uterus or ovaries or hemorrhage (uncontrollable bleeding) of the uterus. Otherwise, the operation is done to improve the quality of life. These reasons may include: heavy bleeding, extreme pain or other chronic conditions. There may be alternative treatments for your condition. You should consider all the alternatives and effects of the different choices to help you decide what is right for you with the input of your personal physician.
Total or Partial Hysterectomy
A total hysterectomy is removal of the entire uterus which includes the cervix. A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix (parametrium), and the upper part of the vagina. A partial (or supracervical) hysterectomy is removal of just the upper portion of the uterus, leaving the cervix intact.
Types of Hysterectomy
TAH - A hysterectomy may be done through an abdominal incision (abdominal hysterectomy) TVH - A hysterectomy may be done through a vaginal incision (vaginal hysterectomy) LAVH - A hysterectomy may be done through a vaginal incision and assisted by laparoscope. (laparoscopic assisted vaginal hysterectomy) LSH - A hysterectomy may be done completely through laparoscopic incisions (small incisions on the abdomen -- laparoscopic hysterectomy). Your physician will help you decide which type of hysterectomy is most appropriate for you, depending on your medical history and the reason for your surgery More specific information about the different types of hysterectomy may be found below.
Total Abdominal Hysterectomy
This is the removal of the uterus and the cervix because together they form the entire uterus.
  • Acronym: TAH
  • Description of procedure: The doctor makes a cut in the abdominal wall to expose the ligaments and blood vessels around the uterus. The muscles in the abdomen are usually not cut, but spread apart with retractors. The ligaments and blood vessels are separated from the uterus and the blood vessels tied off so they will heal and not bleed. Then, the uterus with the cervix, is removed by cutting it off at the top of the vagina. The top of the vagina is repaired by being sewn so that a hole is not left. This is called the vaginal cuff.
  • Indications/contra-indications: This is the best option for you if you are dealing with a cancer possibility, large fibroids, have never delivered a baby vaginally, etc. It is the most invasive of the surgery types and the one that may involve the longest recovery. There is risk of the incision becoming infected.
  • Initial Recovery: Expect 6 to 8 weeks of recovery, with lifting and straining restrictions for this whole period. It is also normal to expect to have a restriction on intercourse for the whole of the initial recovery period.
  • Variations on a theme: It is also possible that your doctor will only do a Supra cervical Abdominal Hysterectomy (SAH), which means that only the main part of the uterus is removed, and the cervix is left in place.
Total Vaginal Hysterectomy
This procedure is the same as in the TAH, performed vaginally
  • Acronym: TVH
  • Description of procedure: The doctor removes the uterus and cervix through a cut in the vagina. As with the TAH the top of the vagina is repaired by being sewn to form the vaginal cuff.
  • Indications/contra-indications: This is usually the surgery of choice if you have prolapse, if there is no possibility of cancer, if your uterus is not too enlarged and if you've delivered vaginally. This type of surgery is not recommended when the surgeon needs to have space to look around, if there is danger of cancer cells or of endo spreading, if you have not delivered vaginally or if your uterus is enlarged beyond a certain size. This surgery can entail additional bleeding. Due to the lack of the presence of an incision, it is easy to forget you've just had major surgery and run the risk of thinking that they are further ahead in their recovery.
  • Initial Recovery: Expect 6 to 8 weeks of recovery, with lifting and straining restrictions for this whole period. It is also normal to expect to have a restriction on intercourse for the whole of the initial recovery period.
  • Variations on a theme: It is also possible that your doctor will may opt to perform a Laparoscopically Assisted Vaginal Hysterectomy (LAVH). If that is the case, the cervix is still removed.
Laparoscopically Assisted Vaginal Hysterectomy
  • Acronym: LAVH
  • Description of procedure: During a LAVH, several small cuts are made in the abdominal wall through which slender metal tubes called "trocars" are inserted to provide access for a laparoscope and other small surgical instruments. The laparoscope is like a tiny telescope with a camera attached to that provides a continuous image which is enlarged and projected onto a television screen.
  • Just like in a TAH or TVH, the uterus (including the cervix) is detached from the ligaments that attach it to other structures in the pelvis, and removed through a cut at the top of the vagina which is repaired with stitches.
  • Indications/contra-indications: Not all women are candidates for laparoscopic hysterectomies and the decision to use this method must be made on an individual basis.
  • Initial Recovery: Expect 4 to 6 weeks of recovery, with some lifting and straining restrictions that could extend beyond this period.
  • Variations on a theme: It is also possible that your doctor will perform a Total Laparascopic Hysterectomy. In this case, the surgery will still be performed entirely laparascopically, but the cervix will be removed.
  • Another possibility is that your doctor will opt to perform a Laparoscopic Supracervical Hysterectomy (LSH). If that is the case, the cervix will be retained.
Laparascopic Supracervical Hysterectomy
This procedure is done completely laparoscopically and does not remove the cervix.
  • Acronym: LSH
  • Description of procedure: The uterus is cut up into small pieces and removed through the tubes which were inserted into the abdomen.
  • Indications/contra-indications: Not all women are candidates for laparoscopic hysterectomies and the decision to use this method must be made on an individual basis.
  • Initial Recovery: Expect 2 to 4 weeks of recovery, with some lifting and straining restrictions that could extend beyond this period.
  • Variations on a theme: It is also possible that your doctor will perform a Total Laparascopic Hysterectomy. In this case, the surgery will still be performed entirely laparoscopically, but the cervix will be removed.
  • Another possibility is that your doctor will opt to perform a Laparoscopically Assisted Vaginal Hysterectomy (LAVH). If that is the case, the cervix will be removed.
Bilateral Salpingo oophorectomy
This involves the removal of both ovaries and of both tubes.
  • Acronym: BSO
  • Description of procedure: Sometimes, both ovaries and fallopian tubes are removed at the same time a hysterectomy is done. When both ovaries and both tubes are removed, it is called a bilateral salpingo-oophorectomy which is usually shortened to BSO. (bilateral=both sides, salpingo =the fallopian tubes, oophore =the ovaries, ectomy = removal)
  • Indications/contra-indications: The removal of ovaries is most often recommended when the ovaries are diseased. Your doctor may also recommend their removal in the case of cancers that are responsive to the hormones produced by the ovaries. If Endometriosis or Adenomyosis is suspected, some doctors will suggest the removal of ovaries. Removal of ovaries will throw you into surgical menopause which may result in hormonal unbalance and might put you at an increased risk for heart disease, some types of breast cancer and might trigger clotting disorders.
  • Initial Recovery: Your recovery will be based on the type of hysterectomy you had.
  • Variations on a theme: Sometimes only the left or right ovary & tube are removed, and this is referred to as RSO or LSO
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