I've now added a new dimension to my surgical practice. It's total laparoscopic hysterectomy (TLH or LTH). It's the newest and ultimate way to perform a total hysterectomy with shorter hospital stay and return to normal activity. It's required my extending my training further up the ladder to be able to perform this operation. I've been performing hysterectomies for 32 years as well as laparoscopies, but this operation is the ultimate melding of the two procedures. Hysterectomies have been performed for many decades, mostly abdominally and vaginally. I was trained initially in doing both back in the 1970's, but over the last few years, the laparoscopic approach added more choices for the surgeon and the patient. The different types of hysterectomies (with or without removal of the ovaries) being done today are as follows:
Total Abdominal Hysterectomy(TAH): Performed with a large incision (laparotomy) (2-3 day stay in hospital)
Total Vaginal Hysterectomy (VH): Performed vaginally with no visible incisions (1-3 day stay)
Laparoscopic Assisted Vaginal Hysterectomy(LAVH): Performed vaginally with laparoscopic assistance. This surgical procedure designed initially to convert a difficult hysterectomy perhaps done abdominally into a safer and easier vaginal hysterectomy. Most of the operation is done initially thru the laparoscope down to the cervix with the cervix being removed by the vaginal approach. (usually 3-4 small abdominal incisions) (1-2 day stay)
Laparoscopic Supracervical Hysterectomy(LSH or LSCH): Performed laparoscopic only with just removal of the body of the uterus and leaving the cervix behind. Uterus is morcellated thru the laparoscopic incision. All surgery is performed laparoscopically. (Outpatient-1 day stay) (Still have cervix and must have pap smears)
Total Laparoscopic Hysterectomy(TLH or LTH): Complete removal of uterus via laparoscopy surgery. All the surgery is done laparoscopically most of the time. Uterus is removed vaginally after hysterectomy is complete and most, if not all suturing is performed laparoscopically to complete the closure of the vaginal vault. (1 day stay)
Confused yet? The type of hysterectomy to be performed depends on many variables including the patient's physical findings and desires as well as the doctor's training and recommendations for what's best and safest for the patient. Not all patients are good candidates for VH, LAVH, LSH, or TLH. I hope this has been informative. Doc
