Hysterectomy Topics

• laparoscopic assisted vaginal hysterectomy
• total laparoscopic hysterectomy
• post operative recovery
• abdominal incisions
• supracervical hysterectomy
• total hysterectomy
• abdominal cavity
• unnecessary reasons
• removal of the uterus
• lavh
• laparoscopes
• laparoscopic techniques
• vaginal canal
• benign conditions
• hysterectomies
• fundus
• gynecologists
• tlh
• ovaries
• cervix

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Hysterectomy, Hysterectomy

Hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called "complete") or partial (removal of the uterine body but leaving the cervical stump, also called "supracervical"). It is the most commonly performed gynecological surgical procedure. In 2003, over 600,000 hysterectomies were performed in the United States alone, of which over 90% were performed for benign conditions. Wu, JM, Wechter, ME, Geller, EJ, et al. Hysterectomy rates in the United States, 2003. Obstet Gynecol 2007; 110:1091 Such rates being highest in the industrialized world has led to the major controversy that hysterectomies are being largely performed for unwarranted and unnecessary reasons.

With the development of the laparoscopic techniques in the 1970-1980s, the "laparoscopic-assisted vaginal hysterectomy" (LAVH) has gained great popularity among gynecologists because the procedure is much less invasive and the post-operative recovery is much faster with fewer complications. LAVH is performed such that the final removal of the uterus (with or without removal of the ovaries) was via the vaginal canal. Thus, LAVH is also a total hysterectomy, namely, the cervix must be removed with the uterus. The "laparoscopic-assisted supracervical hysterectomy" (LASH) was later developed to remove the uterus without removing the cervix using a morcellator which cuts the uterus into small pieces that can be removed from the abdominal cavity via the laparoscopic ports. Total laparoscopic hysterectomy (TLH) involves disconnecting the uterus, and other structures as needed, by operating only through the laparoscopes in the abdomen, starting at the top of the uterus. The entire uterus is disconnected from its attachments using long thin instruments through the "ports." Then all tissue to be removed is passed through the vagina or through the tiny half-inch abdominal incisions. For large multifibroid uteri total laparoscopic hysterectomy can still be performed with the use of in situ morcellation by gynecologists who are experienced in laparoscopic techniques.

It has been postulated, without data, that removing the cervix causes excessive neurologic and anatomic disruption, thus leading to vaginal shortening, vaginal vault prolapse, and vaginal cuff granulations. These issues were addressed in a systematic review of total versus supracervical hysterectomy for benign gynecological conditions, which reported the following findings Lethaby, A, Ivanova, V, Johnson, NP. Total versus subtotal hysterectomy for benign gynecological conditions. Cochrane Database Syst Rev 2006; CD004993 : 1. There was no difference in the rates of incontinence, constipation or measures of sexual function.

It is obvious that supracervical hysterectomy does not eliminate the possibility of having cervical cancer since the cervix itself is left intact. Those who have undergone this procedure must still have regular Pap smears to check for cervical dysplasia or cancer.

Frederick R. Jelovsek, "Having Prolapse, Cystocele and Rectocele Fixed Without Hysterectomy" Menorrhagia (heavy or abnormal menstrual bleeding) may also be treated with the less invasive endometrial ablation.

Source: Wikipedia > Hysterectomy