Previously, hysterectomy was most commonly done making an incision on the abdomen but in the present times science has evolved and given place to more modernized techniques of the same process using a laparoscope. These days hysterectomy is also carried out through the vagina for quicker recovery. Along with the advancement in the surgery, the duration of hospital stay has also increased, as presently, the surgery takes place for a longer time. Now, depending on the medical condition of a patient, there are different kinds of hysterectomy, however, only after taking advice from the doctor, it will be the patients final decision as to which surgery should be performed. The different types of hysterectomy are discussed below.
Total Abdominal Hysterectomy
This is the most frequently used surgery. Based on the reason of the surgery and the size of the area that has to be treated, the incision is made. The incision may range from a 5-inch to a 7-inch cut, usually made at the lower part of the belly. This surgery is basically for the removal of the entire uterus. Therefore, only after very careful examination of the pelvic and infected area, and several attempts at non-surgical cure, is this surgery performed. Extra care is taken presurgery, as this surgery completely impairs the ability for a woman to become a mother ever again.
As a result, this surgery is not performed on women who are of child bearing age, unless their condition is cancerous. During the surgery, the doctor is able to take a look at all the organs of the region and then confirm the infected parts that have to be removed. Doctors usually recommend this method if there are large pelvic tumors or cancers. The demerits of this procedure are that it prolongs the patients stay in the hospital, gives more discomfort post operation and also leaves a visible mark on the belly.
As the name suggests this method is performed by making a cut in the vagina and pulling out the uterus and cervix. This process is best suited for prolapsed uterus, cervical dysplasia or endometrial hyperplasia, because in these conditions the uterus is not too big and the entire abdomen does not need to be examined. Though this is a more challenging procedure, due to the lack of space, yet it is ideal for the condition in which the uterus drops as a result of weak surrounding muscles. The wound is finally closed with stitches.
A narrow tube like instrument with a camera on one end called laparoscope is inserted into the patient’s belly by making a tiny cut. This laparoscope helps the surgeon to view the complete uterus plan the surgery. The surgeon makes 3 or 4 cuts in order to remove the small parts of the uterus. This is an expensive treatment as compared to abdominal hysterectomy.
Laproscopically Assisted Vaginal Hysterectomy (LAVH)
This surgery is basically vaginal hysterectomy which involves the use of a laparoscope. This means that the cancer that will be removed from the incision made in the vagina while the laparoscope will be inserted through the incisions on the belly. The laparoscope here, again, helps to get a clear picture of the upper abdominal area. This kind of surgery is best suited in case of endometrial cancer, mainly to check the spread of the cancer, and also in oophorectomy, which is the removal of the ovaries. However, this procedure is of a longer duration with a longer recovery period and also involves greater complications. Before the surgery, the surgeon makes sure of any major risks that might be involved in this surgery.
The area that forms the base of the uterus and sits at the end of the vaginal canal is the cervix. Now, leaving this cervix as a “stump” when the uterus is removed, the surgery is known as supracervical hysterectomy. The fact, however, remains that this is not an assured surgery for the removal of cancer as there may be parts of cancer left in that stump. Only women who do not need to have their cervix removed are suggested this method. In some cases of severe endometriosis, it is actually better to leave the cervix in its place as it prevents chances of vaginal prolapse. This is so because, in addition to being a simpler surgery, the stump provides certain support to the vagina, which reduces the chances of any kind of dropping out of the internal organs of the vagina through the vaginal opening.
Laparoscopic Supracervical Hysterectomy
Just like vaginal hysterectomy using a laparoscope, the supracervical hysterectomy is also performed using a laparoscope. The diversion in this method being that the cutting of the cervix at the stump is done using a cautery. The tissues that are to be removed are done with the help of a laparoscopic tool. Recovery is quick as compared to other types and there are less chances of menstruation as the endocervix is cauterized or burned.
This is a more complicated and extensive surgery as compared to abdominal surgery. In this procedure, along with the removal of the uterus, the surrounding tissues of the uterus and the upper vagina are also removed. This kind of surgery is performed only in cases of early cervical cancer. This surgery may also incur injury on the bowel and urinary system.