| Hysterectomy is a major surgical procedure that almost always requires hospitalization. Prior to surgery, a series of tests are performed to evaluate general health and to rule out the presence of infection or anemia; routine diagnostic tests include a complete blood count (CBC), urinalysis, chest x-ray, and electrocardiogram (for individuals over age 35 years).
Hysterectomies are performed in an operating room under general anesthesia. Surgeons have many options to consider such as surgical approach, organs to be removed besides the uterus, blood vessels that require ligation during surgery, and whether to perform total or partial procedures. Hysterectomy procedures can be performed through vaginal access, abdominal wall incisions, or small laparoscopic incisions. The access method is determined by anatomic factors such as size of the uterus, patient preference, and the nature and severity of the underlying condition. A vaginal approach is usually performed on individuals who also require bladder or vaginal repair, and when the uterus is not too large. Open abdominal approaches, using either horizontal or vertical abdominal incisions, are used in the presence of pelvic inflammatory disease, tissue scarring from previous pelvic surgery (adhesions), endometriosis, or are used when a uterus is abnormally large or uterine descent or mobility is lacking. Laparoscopic surgeries involve a tiny abdominal incision and the use of laparoscopic tools that pass through a narrow, lighted tube into the surgical area; they are considered less invasive and are preferred by gynecologic surgeons today for most indications. One advantage is the ability to view the surgical procedure on a monitor by using a small laparoscopic telescoping device with a camera. Each type of surgery takes between 1 and 3 hours to perform. Laparoscopic-assisted abdominal procedures take up to an hour longer than other procedures. Abdominal and laparoscopic hysterectomies are now more common (75%) than vaginal hysterectomies (Parker).
A laparoscopically assisted vaginal hysterectomy (LAVH) combines a laparoscopic procedure requiring two or three small abdominal incisions with a vaginal wall incision. Similarly, a laparoscopic-assisted abdominal hysterectomy combines laparoscopic incisions with a vertical or horizontal abdominal incision. In these surgeries, the laparoscopic part of the procedure is finished before the uterine arteries are incised (ligation) through either the vaginal or abdominal incision. After removal of the uterus and other structures (ovaries, tubes), laparoscopic and abdominal incisions are closed with sutures or staples. Average recovery time from a combined procedure is approximately 4 to 6 weeks.
Increasingly, supracervical hysterectomy is being performed to remove the uterus and spare the cervix. In this procedure, the uterus may be broken into small pieces (morcellated) rather than incised. “Cutting current” may be used to cauterize the cut end of the cervix. Surgeons who prefer this procedure suggest that keeping the cervix is less apt to disturb nerves related to bladder and bowel function, thereby reducing complications. Sexual function is also thought to be preserved by retaining the cervix. Supracervical procedures can be performed abdominally or laparoscopically and are generally simpler procedures that take less time to perform. Recovery times parallel those of other types of hysterectomy. One possible disadvantage of the procedure is that risk of cervical cancer is not eliminated. |
Source: Medical Disability Advisor