Approaches to Hysterectomy
Fortunately, there are more choices than ever before for the type of hysterectomy, as well as the surgical approach (open, vaginal or laparoscopic hysterectomy).
Also referred to as an Abdominal Hysterectomy. Surgeons perform the majority of hysterectomies using an open approach. With open surgery, your doctor must make a large abdominal incision – large enough to fit his/her hands and instruments inside your body. While open surgery allows your surgeon to see and touch your organs, there are some drawbacks for patients due to the long incision.
Minimally Invasive Hysterectomy
This includes vaginal, laparoscopic and robotic approaches to hysterectomy and all share the benefits of a short hospital stay, less pain, quicker recovery, and lower costs.
With vaginal hysterectomy, the uterus is removed through the vagina, without any external incision. Surgeons may use this minimally invasive approach if the patient's condition is benign (non-cancerous), or when the uterus is a normal size and the condition is limited to the uterus. With vaginal hysterectomy, surgeons have a small working space and lack of view to the pelvic organs.
During a traditional laparoscopic hysterectomy, long and thin surgical instruments are inserted through a few small incisions instead of a large open incision. One of the instruments is a laparoscope – a lighted tube with a camera at the end. The camera takes images inside the body and sends those images to a video monitor in the operating room which guides surgeons as they remove your uterus.
Robotic Assisted Laparoscopic Hysterectomy
With a robotic assisted hysterectomy, surgeons operate through a few small incisions - similar to traditional laparoscopy. The da Vinci System is the device used currently and features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. For more complex hysterectomies, such as patients with gynecologic cancers, the surgeon may choose to use robotic assisted surgery. It is important to remember that robotic surgery is another tool that allows surgeons to accomplish minimally invasive surgery.
Types of Hysterectomy
There are many types of hysterectomy that are performed, depending on the patient's diagnosis. All hysterectomies involve removal of the uterus. What can vary are which additional reproductive organs and other tissues that may be removed. Types of hysterectomy include:
Partial or subtotal hysterectomy: This procedure, also known as a supracervical hysterectomy, involves removing the uterus, but leaves the cervix intact. This decision is often based upon patient preference. Some women feel that leaving the cervix intact will preserve sexual function following surgery.
Total hysterectomy: This procedure is most often performed for cervical cancer, and involves removal of the uterus, tissues next to the uterus, the upper part (about 1 inch) of the vagina and pelvic lymph nodes. The fallopian tubes and ovaries may also be removed.
Removal of lymph nodes: For hysterectomies performed for malignant conditions – such as uterine, cervical, or ovarian cancer – the surgeon will also remove certain lymph nodes. This procedure is often referred to as a lymph node dissection or lymphadenectomy. Lymph nodes will be removed in certain areas, depending upon the location and extent of the disease. Lymph node removal also helps your surgeon determine the extent or stage of your cancer, and can guide further adjuvant treatment, such as radiation therapy or chemotherapy.
Removal of the fallopian tubes and ovaries: These organs may or may not be removed during your hysterectomy procedure. This will depend upon your condition, age, and other factors. Often, the ovaries are left intact. Removal of the ovaries is called an oophorectomy. Removal of fallopian tubes and ovaries is called a salpingo-oophorectomy. It is recommended to remove the fallopian tubes at the time of hysterectomy because of evidence that links the most common type of ovarian cancer to originating in the fallopian tube. This is called a salpingectomy..
Radical hysterectomy: For this procedure, the uterus and cervix are removed along with lymph nodes and the upper one third of the vagina. This is necessary for women who have invasive cervical cancer.