Laparoscopic vs. Vaginal Hysterectomy
A hysterectomy is a surgical operation to remove all or part of your uterus. More than 600,000 hysterectomies are performed in the United States each year; it is one of the most commonly performed surgeries.
The three broadest categories of hysterectomies are:
- Abdominal Hysterectomy – The most common approach to a hysterectomy (65% of all hysterectomies), an “open” hysterectomy involves a surgeon making a 5-7 inch incision in your abdomen and removing your uterus through this incision.
- Laparoscopic Hysterectomy – This surgery is done using an instrument known as a laparoscope (a tube with a lighted camera) and surgical tools inserted through several small cuts made on your belly, or one small cut made inside your belly button.
- Vaginal Hysterectomy – This procedure involves a surgeon making a cut in your vagina and then removing your uterus through this incision.
What are the advantages of a getting a laparoscopic hysterectomy?
- Infection: The risk of infection is lowered during a minimally invasive procedure because smaller incisions are made.
- Less Blood Loss: Because the incisions are small you will lose less blood than a hysterectomy, which involves a much larger incision.
- Less Scarring: Small incisions make for less scarring.
- Less Postoperative Pain: Because there is no chance of damage to your organs and no severing of muscle tissues to get through your abdomen, your postoperative experience will be pleasant in comparison to open surgery.
- Outpatient Basis: You don’t have to be admitted to a hospital to get a laparoscopic hysterectomy.
- Recovery: Recovery for a laparoscopic hysterectomy takes almost two weeks, a short period when compared to open hysterec which hat takes nearly two months to recover.
You can either choose to keep the cervix in place (supra-cervical hysterectomy) or remove the entire uterus, including the cervix (total laparoscopic hysterectomy). If your ovaries are removed during your hysterectomy, you will need to get on hormone therapy. If you keep your ovaries inside you, don’t have to take any hormones after your surgery, and you will not have hot flashes.
What are the advantages and disadvantages of keeping my cervix in place?
- Advantages: Keeping your cervix makes the operation a little bit faster and safe. Some think that if you keep your cervix, you will have better sexual enjoyment in the future.
- Disadvantages: When the cervix is left in place after a hysterectomy there is a 5% chance you will experience monthly spotting around the time of your period each month. You also need to keep getting regular pap smears if you keep your cervix in place.
What situations would require me to have my cervix removed along with my uterus?
- Endometriosis: If your hysterectomy is being performed for endometriosis (when tissue from the wall of your uterus appears outside your uterus) and chronic pelvic pain, removal of your entire uterus (including your cervix) is recommended to give you the best chances of pain reduction possible.
- Desire to Cease Menstruation Permanently: It’s pretty straightforward; if you are 100% sure that you never want to menstruate again, the only way you can achieve that is to have 100% of your uterus removed.
- History of Pre-Cancerous Changes: If you have a history of pre-cancerous changes taking place around your cervix or uterine lining, you should have your entire uterus removed to ensure that cancer doesn’t grow in those regions.
If you want to get rid of fibroids, abnormal uterine bleeding, pelvic prolapse, cervical abnormalities, endometrial hyperplasia, or chronic pelvic pain, a vaginal hysterectomy can help a lot with these issues.
What are the statistics on laparoscopic hysterectomy vs. vaginal hysterectomy?
A Cochrane review comparing 34 randomized trials of all the different types of hysterectomies and their outcomes showed that vaginal hysterectomy has the best outcome out of the possible hysterectomy routes you can take.
Some factors make it difficult or unwise for a surgeon to perform a laparoscopic effectively and safely. These factors are:
- Gynecological Cancer: Women with gynecological cancer are left out of this type of hysterectomy because the chance of leaving a piece of a tumor behind is not worth the risk.
- Obesity: If you have too much fat on your body and your abdomen it will prevent the surgeon from being able to manipulate their way through your abdominal and pelvic areas enough to remove your uterus.
- Previous Operations: If you have had multiple previous operations in your lower abdomen, getting a laparoscopic hysterectomy is not recommended.
- Uterus Size: If your uterus is bigger than a four-month pregnancy you should not have a laparoscopic hysterectomy.
The following situations have been proposed as indications for when a vaginal hysterectomy is not recommended:
- Enlarged Uterus
- Narrow Vagina
- Prior Cesarean Delivery
- Undescended Immobile Uterus
Talk to your doctor about which route of hysterectomy is right for you. Despite the fact that all the information about hysterectomies is a little intimidating, your doctor is there to help you and figure out what is best for you. Don’t hesitate to ask any and all questions you may have concerning laparoscopic hysterectomy vs. vaginal hysterectomy.
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