Types of Hysterectomy

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Hysterectomy, then and now-

In the past, surgical removal of the uterus was commonly carried out by abdominal hysterectomy. This meant it was done by an incision through the abdomen. The incision could be either horizontal or vertical depending upon the area which had to be explored surgically. Nowadays, hysterectomies can also be done by laparoscopy or through the vagina. These methods ensure a safer, shorter procedure with a quicker recovery time.

Type one- Total Abdominal Hysterectomy

Total abdominal hysterectomy is however still the most common type. It is carried out in at least 66% of all hysterectomies. In this procedure the uterus as well as the cervix is removed.

This is usually done to remove large fibroids in the uterus, in cancer of the ovary(s) or uterus, and for endometriosis. With this procedure the whole of the insides of the abdomen and pelvic cavity can be examined to check for any spread of endometriosis as well as cancer. The ovaries as well as the Fallopian tubes may also be removed when there are complications of infection, or for cancer.

Type two- Vaginal Hysterectomy

Vaginal hysterectomy, when feasible, is the safest and most cost-effective procedure for removal of the uterus. About 22% of of hysterectomies are performed vaginally. It is never carried out in pregnancy or in cancers. Other factors that can contra-indicate a vaginal hysterectomy are a large uterus, a narrow vagina or pubic arch, possibility of adhesion, and other pathologist in the tissues surrounding the uterus.It can be performed with either general anesthesia or regional anesthesia. The vaginal route, when feasible, compared with all other routes for hysterectomies, yields better outcomes and fewer complications.

Type three- Laparoscopic vaginal hysterectomy
Laparoscopy-assisted vaginal hysterectomy is the same as a vaginal hysterectomy but with the use of a laparoscope. A laparoscope is a very thin viewing tube used to visualize structures within the abdomen. It allows the upper abdomen to be carefully inspected during surgery to check for any cancers.This procedure has certain advantages:  a faster return to normal activity, shorter hospital stay, reduced intra-operative blood loss, and fewer wound infections. The disadvantages are a longer operating time and higher rate of urinary tract injury.

Type four- Supra Cervical Hysterectomy

A supra cervical hysterectomy removes the uterus while sparing the cervix, leaving it as a "stump." The possibility of developing cancer in this remnant "stump" remains. It is not done when there are abnormal Pap smears or cervical cancer. This is a simple and quick procedure. The cervix may be left in place if there is no good reason to remove it. It gives added support to the vagina and decreases the chances of prolapse. Also in severe endometriosis it is better left in place.

With laparoscope assisted procedure recovery is generally faster than with other types of hysterectomies. The inner lining of the cervix is cauterized thereby reducing any chance of period bleeding.

Type five- Radical Hysterectomy
Radical hysterectomy is a more extensive surgery than a total abdominal hysterectomy because it also includes removing tissues surrounding the uterus and removal of the upper vagina. It is usually performed for early cervical cancer. There are more complications with radical hysterectomy compared to abdominal one. These include injury to the bowels and urinary system. The ovaries as well as the Fallopian tubes may also be removed when there are complications of infection, or for cancer.Occasionally, women with inherited types of cancer of the ovary or breast will have their ovaries removed as preventive surgery. This reduces the risk of future cancer of the ovary or breast. Current recommendations are that the Fallopian tubes should be removed during hysterectomies even if the ovaries are preserved. This is done to decrease the lifetime risk of ovarian cancer, which can arise from the Fallopian tubes in up to 25% of case.

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