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
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 (regardless of their
size or number), an abdominal incision (TAH) is rarely required to complete
the operation. These procedures can usually be completed vaginally or
with laparoscopic assistance. These cases are also amenable to laparsocopic
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, some as early as 18 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.