January 15, 2017 Liza Colimon, MD Hysterectomy is the term used to describe a gynecologic surgical procedure which is performed to remove the uterus and cervix. Indications for Hysterectomy Why would you need a hysterectomy? If you are experiencing one of the following conditions: Abnormal Uterine Bleeding Fibroids Chronic pelvic pain Endometriosis Cancer or Precancerous Conditions Prolapse There are two types of hysterectomy: A Total hysterectomy and a Supracervical Hysterectomy. A Total Hysterectomy involves removing the uterus and the cervix. When a Supracervical Hysterectomy is performed only the uterus is removed and the cervix is left in it’s normal anatomical position. A Hysterectomy is the preferred surgical treatment for patient’s who desire definitive surgical management for uterine problems affecting one’s health or overall quality of life. Keep in mind having a Hysterectomy Procedure has nothing to do with your ovaries. This is a separate procedure called an Oophorectomy. Surgical Approaches to Hysterectomy Procedures These are the four approaches to performing Hysterectomy. Vaginal Hysterectomy Laparoscopic Assisted Hysterectomy Robotic Assisted Laparoscopic Abdominal Hysterectomy Which Procedure you have will be determined by your medical and surgical history, your physical exam findings and the skill level and experience of your surgeon. Vaginal Hysterectomy This procedure is considered the least invasive surgical approach to perform a Total Hysterectomy. A Supracervical Hysterectomy cannot be performed vaginally. The uterus and cervix is removed entirely from the vagina. No abdominal incisions are required. Specific patients may be candidates for this type of hysterectomy depending on how many children one has had, whether or not you have had multiple cesarean deliveries, your surgical history, the absence of large fibroids and other factors which will be determined during your office visit and pelvic exam. Your ovaries may be removed vaginally as well if indicated and this procedures is often combined with other vaginal surgical procedures performed to repair prolapse and urinary incontinence. The advantages of vaginal over traditional laparoscopic or abdominal surgery include a shorter recovery, less pain, and absence of abdominal incisions. Laparoscopic Hysterectomy Laparoscopic surgery is a type of minimally invasive surgery in which small incisions between 0.5 to 1 cm are made on the abdominal wall (belly). A laparoscope is a very small instrument shaped like a long rod with a camera inside of it that is then placed inside the abdomen. The laparoscope allows the surgeon to see inside the abdomen and pelvis to diagnosis normal anatomy, or abnormal anatomy that could effect the bowel, appendix, liver, pelvic organs such as the uterus, ovaries and fallopian tubes. The abdominal cavity is able to be visualized by filling it with an absorbable gas, typically, carbon dioxide. Small instruments can be placed through these incisions allowing the surgeon to remove the uterus and cervix without the need for a large abdominal incision (laparotomy). Patients must receive general anesthesia during the procedure and typically go home the same day or stay overnight in the hospital for monitoring. Advantages of laparoscopy over traditional abdominal surgery include: Shorter post-operative hospital stay Shorter recovery interval Less pain Less blood loss Decreased risk of post surgery intra-abdominal scar formation that can cause future pain Robotic-Assisted Laparoscopic Hysterectomy A Robotic- assisted Laparoscopic Hysterectomy is a type of minimally invasive hysterectomy utilizing robotic technology. The procedure is performed using a similar approach to that performed during a Laparoscopic Hysterectomy. Small incisions ranging in size from 1-1.5 cm are made on the abdominal wall. However the da Vinci robot is utilized which allows the surgeon enhanced three-dimensional visualization and improved maneuverability for suturing the vagina closed once the uterus and cervix are removed. During the procedure, the surgeon sits at a console a few feet from the operation table looking through a monitor that provides a three dimensional view. From that console the surgeon directly controls the robot, which has arms for operating all instruments and also the ability to move, zoom and focus a robotic camera. Both hand controls and foot pedals are used to control all of the robotic instruments directly which can grasp, cut, burn, cauterize and suture (sew) inside the pelvis. Like laparoscopic surgery, robotic- assisted procedures allow for a faster recovery, shorter post-operative stay, and less pain than the traditional abdominal approach.