The different ways hysterectomy can be performed

When you and your gynecologist have decided on hysterectomy as the treatment of choice for your gynecologic diagnosis, there are several routes by which a hysterectomy may be accomplished. A total hysterectomy is the surgical removal of the uterus, and when indicated, the additional removal of the fallopian tubes and ovaries (termed salpingoophorectomy) may be recommended.

There are several routes by which a hysterectomy can be performed. You and your gynecologist will decide on the safest route for your hysterectomy based upon the reasons and clinical circumstances for the hysterectomy, your health history and the surgeon’s clinical expertise.

The 4 main routes by which a hysterectomy is performed are abdominally, laparoscopically, da Vinci assisted laparoscopically or vaginally. In an abdominal hysterectomy an abdominal skin incision (similar to a cesarean section incision) is made to accomplish the surgery. This route is especially advantageous when large uterine fibroids or significant abdominal adhesions are anticipated, allowing for more exposure to accomplish the surgery safely. Compared with the other minimally invasive routes, abdominal hysterectomy generally requires a longer hospital stay and longer recovery time.

Laparoscopic hysterectomy involves the use of a narrow camera (termed a laparoscope) and surgical instruments placed through small abdominal skin incisions to detach the uterus, which is then most commonly delivered through the vagina. This route may be selected when abdominal adhesions or a moderate-to-large sized uterus are suspected. The advantage with this minimally invasive approach is a shorter hospital stay and faster recovery time, when compared with abdominal hysterectomy. Your surgeon may offer da Vinci hysterectomy for more complex procedures.

In the vaginal route (termed vaginal hysterectomy) the uterus is completely removed through the vagina, thereby avoiding any abdominal incisions. This route may be selected for a normal-to- moderately enlarged uterus, for pelvic organ prolapse, or when significant abdominal adhesions are not suspected. As with laparoscopic and Davinci hysterectomy, a shorter hospital stay and faster recovery are expected.

Though hysterectomies are the most common gynecologic surgery performed among women in the United States , any surgical procedure has inherent risks. Hysterectomy may be the best choice for your gynecologic condition. Be sure to consult with your physician in understanding the risks versus benefit — and your options.

Suzanne Hall is an obstetrician-gynecologist at Eastside Gynecology Obstetrics in Roseville, Michigan.  She can be reached on Twitter.

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