Dr. Desai discusses Hysterectomy Techniques

There are many ways to do a hysterectomy.  Before we get to that, though, let’s define the different types of hysterectomy.

A total hysterectomy implies that the cervix will be removed.  A supracervical hysterectomy, on the other hand, means that the cervix will be left behind.

Removal of the tubes and ovaries is called a bilateral salpingo-oophorectomy.

The last type of hysterectomy (for our purposes) is a radical hysterectomy. This type is done almost exclusively by gyn-oncologists.  They are Ob/Gyns who have spent two or three years after residency training in the treatment of women with cancer of the uterus, tubes, ovaries, vulva, and vagina.  Most women who
have stayed current with their annual exams and pap smears will never encounter the need for a radical hysterectomy.

With the definitions out of the way, I’ll bore you with a little bit of history. Until about 10 years ago, the vast majority hysterectomies in the United States were done abdominally or vaginally.  That means that the uterus was removed either by making an incision on the abdomen (either vertically or a “bikini-cut”) or by cutting the support structures through the vagina.  As you can imagine, to cut support structures and blood vessels through the vagina, it is important the the uterus not be too big.  Additionally, most gynecologists
are hesitant to use the vaginal approach in women in whom the uterus has not descended (fallen) at least a little or in women who have had a  lot of abdominal surgery.  The advantage to the vaginal hysterectomy, though, is fairly obvious.  It allows a much faster recuperation, and in many cases requires no more than an over night stay in the hospital.  Abdominal hysterectomies generally require at least a two day hospital stay and involve a longer recuperation.  The advantage to the abdominal hysterectomy, though is that it
allows the gynecologist to very clearly see and feel the structures that need to be cut and tied. It also allows us to remove very large structures that would otherwise not fit through the vagina.

About twelve years ago, Drs. Tapia and Haddox of Volusia Ob/Gyn performed the first laparoscopic assisted supracervical hysterectomy (LASH) in Volusia County.  The laparoscope is a camera (about 5 mm wide) that is now used in many abdominal surgeries in the United States.  With the laparoscope, we can see into the abdomen as we cut support structures, ligaments, and blood vessels.  This is itsadvantage over the vaginal approach.  In addition to the 5mm incision (made just under the belly button) we make two more incisions on the lower abdominal wall. One is 5 mm and the other is a centimeter.  Through these incisions we can cut and coagulate the structures that are feeding and supporting the uterus.  With the laparoscopic approach, we can remove a very large, undescended uterus, we can be certain that we can remove the ovaries (which we may or may not be able
to do vaginally), and we can send you home the day of or the day after surgery.  As you can see, then, the LASH combines the advantages of the abdominal and vaginal approaches.  As the name implies, most hysterectomies done through the laparoscope leave the cervix behind.  If you have a history of abnormal pap smears or any other indication to have your cervix removed, though, we can
perform a total laparoscopic hysterectomy.  Once the uterus has been freed from its support structures and blood supply, we remove it from the abdomen through a process called morcellation.  This involves cutting the uterus (and ovaries if necessary) into 1  cm strips with an instrument called a morcellator. The LASH allows us to combine the exposure and direct visualisation of an abdominal hysterectomy with the (usually) rapid recovery of a vaginal approach.

Still, if possible, we will perform a vaginal hysterectomy (because the only thing better than small abdominal incisions is NO abdominal incisions).

About 95% of the hysterectomy performed at Volusia Ob/Gyn are done laparoscopically (well above the national average).  Our results have been excellent and our complication rate has been at or below the national average.  Additionally, we have trained other gynecologists in the county on the techniques and methods
involved in performing this operation. If you have any questions regarding LASH or anything else, feel free to contact us. Also we have an actual procedure video under our “services and links” tab.

Dr.M. Desai