Gynecological Surgeries
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| Hysterectomies |
Hysterectomy is an operation in which your doctor removes your uterus. If you and your doctor decide one or both ovaries should also be removed at the time of your hysterectomy, then that is called “oophorectomy”, or removal of an ovary (or even “salpingo-oophorectomy”, which is removal of the fallopian tube and ovary).
Since estrogen and progesterone, among other hormones, are made by the ovaries, removing the uterus won’t make you go prematurely into menopause. If one ovary is removed, leaving the other in its place, you still will not go into premature menopause (you know, hot flashes, mood changes, vaginal dryness, and so forth). A hysterectomy is done in the hospital, where an anesthesiologist will administer general anesthesia—you won’t be awake or aware of any part of the operation.
With the uterus is gone, you won’t have periods or be able to become pregnant. Many studies have been done to see if removing the uterus changes a woman’s sexuality. The consensus is that there is no change in a woman’s sex drive (libido), enjoyment of sex, or ability to have an orgasm. There are several different ways in which your doctor can remove your uterus, with or without removing the tubes and ovaries at the same time. Which procedure is the right one for you depends on a few things, including your preferences, what surgeries you may have had in the past, and the reason why your uterus is being removed.
We at Linn County OB-Gyn can tailor hysterectomies to a patient's lifestyle—for example, a woman could return to work within 4 to 7 days if she meets certain requirements after her surgery. The different types of hysterectomies are summarized below:
Total abdominal hysterectomy (TAH) : An incision is made in your abdomen, usually in a horizontal direction (sort of a “bikini cut”). The incision usually is about five inches long and is close to the pubic hairline. Rarely, your doctor may use a vertical incision instead of the horizontal incision. You are usually given four to six weeks off work, although you’ll be feeling well long before that time is up. A woman typically spends between one and three days in the hospital.
Total Vaginal Hysterectomy (TVH) : An incision is made in the back of your vagina, and all the tissues that keep the uterus attached in your pelvis are carefully disconnected so the uterus can be removed through this vaginal incision. There are no visible incisions, and patients tend to go home the day after surgery. You are usually given four to six weeks off work, although you’ll be feeling well long before that time is up.
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Laparoscopic-Assisted Vaginal Hysterectomy (LAVH): This is virtually the same as TVH (see above), except three small incisions are made in the abdomen to make removing the uterus and/or ovaries through the vagina easier and safer. These incisions are about a quarter of an inch long—one is made inside your belly button and will be virtually unnoticeable after surgery. The other two are made in the skin of the lower abdomen, one on each side. The belly button incision is made so your doctor can place a pencil-thin camera inside your abdominal cavity and see all your pelvic organs displayed on a monitor. The other two incisions allow him to place very thin instruments inside the abdominal cavity to help disconnect the uterus and/or ovaries from their attachments inside your body. Women usually get to go home the day after surgery.
Laparoscopic Supracervical Hysterectomy ( LSH): This one is a little different from the LAVH in that no incision is made in the vagina—recovery time (when you feel “back to normal”) is quite short. A quarter-inch incision is made in your belly button, and a pencil-thin camera is inserted through this incision so your doctor can see everything in your pelvis on a monitor. Two other incisions are made in your lower abdomen, one on each side. They are a little less than half an inch long. Your doctor can use specially designed surgical instruments to perform the hysterectomy through these small incisions. Your uterus is disconnected from its attachments in the pelvis and then removed in pieces through one of the small incisions in your abdomen. The cervix is left in place. The patient can sometimes go home later that same day, or sometimes she will go home from the hospital the day after surgery.
Total Laparoscopic Hysterectomy (TLH) : Three small incisions are made in the abdomen to make removing the uterus and/or ovaries through the vagina easier and safer. These incisions are about a quarter of an inch long—one is made inside your belly button and will be virtually unnoticeable after surgery. The other two are made in the skin of the lower abdomen, one on each side. The belly button incision is made so your doctor can place a pencil-thin camera inside your abdominal cavity and see all your pelvic organs displayed on a monitor. The other two incisions allow him to place very thin instruments inside the abdominal cavity to help disconnect the uterus and/or ovaries from their attachments inside your body.
After the uterus (and cervix) have been disconnected from their attachments in the pelvis, the uterus is removed through the vagina. The surgeon then uses the laparoscopic instruments to sew the back of the vagina closed again (the vaginal cuff). After this procedure, the patient can go home the day after surgery.
Robotic-Assisted Total Laparoscopic Hysterectomy: This is very similar to TLH (see above), with one important difference. Highly sophisticated robotic arms are attached to the instruments mentioned in the TLH. Your doctor then sits at a console in the operating room and controls the robotic arms from that console. The potential advantage in having the robotic assistance is that your doctor can see your pelvic organs in 3-D instead of in two dimensions (like images on a TV screen). Also, the robotic arms allow the doctor greater range in his movements than with traditional laparoscopic instruments. The U.S. Food and Drug Administration (FDA) approved the da Vinci robot for use in gynecologic surgery in April of 2005, and this is only approved machine available for this purpose. Linn County OB-GYN is the only private OB-GYN practice in Eastern Iowa where all physicians can provide the robotic option for patients. If you’d like more information about this new option, please visit the da Vinci website at Intuitive Surgical.
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