Hysterectomy is one of the most commonly performed gynecologic surgeries in the United States. Approximately 700,000 women undergo the procedure each year for a variety of conditions ranging from endometriosis to cancer. Unfortunately, 70% of these procedures are still performed through an abdominal incision (laparotomy). This is termed “Total Abdominal Hysterectomy” or “TAH”.
With rare exceptions (particularly some types of cancer) these hysterectomies can safely be performed vaginally (with or without the assistance of laparoscopy) or totally by laparoscopic techniques. Laparoscopy (“belly-button surgery”) is commonly used to assist in the vaginal completion of the operation in those cases that would otherwise require an abdominal incision.
When the hysterectomy is being performed for endometriosis, laparoscopically assisted vaginal hysterectomy (LAVH) is preferable to an open procedure. In this situation, endometrial implants are removed along with the uterus (and possibly the ovaries). If endometrial implants are left behind (even when the uterus and/or ovaries are removed), pain from endometriosis may continue after surgery. Operative laparoscopy allows the surgeon to accurately and completely remove implants of endometriosis prior to vaginal removal of the uterus.
If the hysterectomy is being performed for fibroids, an abdominal incision (TAH) is rarely required to complete the operation. These procedures can usually be completed vaginally or with laparoscopic assistance.
Patients undergoing hysterectomy for pelvic pain (for which no cause has been found) benefit from laparoscopic evaluation of the pelvis as part of their procedure. Laparoscopy allows the surgeon to inspect the abdomen and plan the proper procedure accordingly. If a cause for pain is identified, it is treated laparoscopically and the hysterectomy completed vaginally.
Many patients who have had previous abdominal surgery (cesarean section, ovarian cysts, fibroids, adhesions, endometriosis, tubal pregnancy) are told they will require an abdominal incision to complete their hysterectomy. In most cases, this is unnecessary. A gynecologist skilled in laparoscopic surgery will usually be able to complete the hysterectomy using a combination of laparoscopic and vaginal techniques. This provides the patient with the unquestioned benefits of vaginal surgery and avoids those problems associated with an abdominal incision.
Regardless of the pathology leading to hysterectomy (with the exception of cancer) most patients undergoing vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH) will go home within 48 hours of their surgery, many as early as 24 hours. Most are able to resume normal activities between 10 and 21 days following surgery. In uncomplicated cases, vaginal hysterectomy and LAVH save 1 to 2 days in the hospital, 2 to 4 weeks recovery, and avoid a lot of postoperative pain.
