| |
What is a Total Laparoscopic Hysterectomy (TLH)?
Every hysterectomy involves removal of the uterus, and sometimes the ovaries are removed with the uterus (oophorectomy). But, each hysterectomy should be done by the most appropriate route, in the least debilitating way, allowing the speediest recovery of function.
Total Abdominal Hysterectomy (TAH): This most commonly performed surgery requires a four to eight inch abdominal incision to remove the uterus, and ovaries, if needed. It can be done for any size uterus, regardless of whether she has had children (which relaxes and loosens the pelvic organ connections and widens the vagina). There will be a four to eight inch abdominal scar, either sideways or up-and-down, as required for the specifics of each case. This procedure usually entails four to six days in the hospital and four to six weeks away from work to recover. It is the least preferred route by patients because of the hospital stay, abdominal scar, pain, and disability; but it is sometimes the only route possible. Virtually every operating OB/GYN doctor can do this procedure, except when cancer is suspected, then a Gynecologic Oncologist should be consulted.
Vaginal Hysterectomy (VH): This is the next most frequently employed technique of hysterectomy. The surgeon operates entirely through the vagina, pulling the uterus down through the vagina into view, disconnecting the cervix and then the rest of the uterus. To use the vaginal route, a woman must usually have had a baby or two which widens the vagina and relaxes the connections of the uterus so it can be pulled down into the vagina to do the operation. There is no abdominal scar. It usually requires only two days in the hospital and about two weeks away from work. Vaginal hysterectomy is always preferred route if all the specific requirements are met--smallish uterus, no cancer, vaginal laxity. Virtually every operating OB/GYN doctor can do this procedure. It can not always be done for massive uteruses, and it is almost impossible to do for women who have never delivered babies vaginally. It is also not always possible to remove the ovaries because they are attached much higher in the pelvis than the uterus and cannot always be pulled down into the vagina for surgical removal.
Laparoscopy: This type of surgery involves passing from one to five small plastic tubes through half-inch incisions in the abdominal wall, providing a video picture of the inside of the abdominal cavity. Long slender surgical instruments can be used through these tiny "ports" to perform operations, such as removing the uterus, ovaries or performing biopsies.
Laparoscopic Assisted Vaginal Hysterectomy (LAVH): This also involves removal of the pelvic organs through the vagina but includes starting with cutting the ovarian attachments by working through the laparoscopes in the abdomen. It is done this way because of suspicions that the ovaries probably cannot be disconnected by operating only through the vagina. LAVH is performed on women who can have a vaginal hysterectomy but need to be certain the ovaries are removed, or who have had surgeries which make the vaginal route alone more risky or less successful. There still must be vaginal laxity and openness. Abdominal scars consist of two to four half-inch incisions. Usually two days in the hospital are needed with two weeks away from work. This is the next most preferred route for qualifying women. Most operating OB/GYN doctors can do this procedure, but not all.
Total Laparoscopic Hysterectomy: This procedure involves disconnecting the uterus, and other structures as needed, by operating only through the laparoscopes in the abdomen, starting at the top of the uterus. The entire uterus is disconnected from its attachments using long thin instruments through the "ports." Then all tissue to be removed is passed through the vagina or through the tiny half-inch abdominal incisions. A massive ovarian cyst can be removed without rupturing it inside the abdominal cavity by placing it in a sturdy surgical-grade pouch and passing the pouch out the vagina or, after collapsing the cyst inside the pouch, passing it out through the "port" incision. If the uterus is massively enlarged it can be disconnected from its attachments, then cut into tiny pieces and passed down the vagina. If a cancer is present, it can be removed with the staging procedures such as lymph node sampling, appendectomy, and omentectomy done safely. Abdominal scars consist of two to four tiny one-half inch incisions, one inside the belly-button, one in the top portion of the pubic hair just above the pubic bone, and one each just to the middle side of the front of the hip bone. Two days in the hospital and two weeks away from work are usual. Because there is no operating through the vagina (though tiny pieces of tissue can be passed down through it), there is no requirement for a wide vagina or loose ligaments. TLH can thus be performed on women who have never had children, women with narrow or long vaginas, women with previous surgeries, women with cancer, and women with massive organs. This technique is the least painful and least debilitating route of surgery for women who need hysterectomy but do not qualify to have a vaginal hysterectomy. Very few of today's operating OB/GYN doctors have learned this procedure which has been available for about five years, but young doctors who are current residents at Stanford are now being trained to perform it, as are the physicians who come from all over the nation to participate in the Stanford Endoscopic Center for Training and Technology courses.
|
