Choose the Right Type of Hysterectomy With Utmost Care
Type of hysterectomy becomes important factor when you have already decided to go for it, or at least when you are giving the whole notion a serious thought. However, any type of hysterectomy will still be a hysterectomy -- a major gynecological operation, involving removal of at least the uterus and performed in general anesthesia.
The types of hysterectomy are usually given their own shortcuts and these are:
| TAH |
Total abdominal hysterectomy surgery |
| VH |
Vaginal hysterecomy surgery |
| LH |
Laparoscopic (laproscopic) hysterectomy surgery |
| LAVH |
Laparoscopically assisted vaginal hysterectomy or laproscopic assisted vaginal hysterectomy |
| LSO |
Removal of left ovary and fallopian tube |
| RSO |
Removal of right ovary and fallopian tube |
| BSO |
Removal of both ovaries and fallopian tubes |
| TAH/BSO |
Total abdominal hysterectomy with removal of both ovaries and fallopian tubes |
Type of Hysterectomy According to the Parts Removed
Total hysterectomy is taking out the entire uterus, altogether with cervix.
Many lay people wrongly think that the term "total" here means taking both the uterus and the ovaries, but that is not correct. The phrase "complete hysterectomy" is also frequently used to describe taking "everything out".
Subtotal hysterectomy is taking out only the uterus, while leaving the cervix in place. Tubes and ovaries may or may not be removed. This procedure is always done through the abdomen.
In recent years, there is a heightened interest in subtotal hysterectomy, as the common sense dictates that the sexual enjoyment will be greater of the cervix is left in place. Contrary to that, hard evidence (interviewing women with and without cervix left in place after a hysterectomy) shows that sexual pleasure is the same with or without cervix out there.
After subtotal hysterectomy, a woman still needs to have regular Pap smears to prevent cervical cancer.
Radical hysterectomy is taking out not only the cervix, uterus and fallopian tubes, but also the upper third of the vagina and the tissues around the cervix. Radical hysterectomy really is a surgical way of removing the cancer of cervix, so the pelvic lymph glands will also be removed at this time. Ovaries may well be target for the radical hysterectomy, but it is up to your doctor to assess whether that should be so.
Should Ovaries Be Removed As Well?
The latin name of the ovaries is "oopher" and for the tubes, it is "salpinx". So, oophorectomy is taking the ovaries out, and salpingo-oophorectomy is taking both the ovaries and the tubes out. If done on both sides, it will be called bilateral salpingo-oophorectomy, and is usually shorthened as "BSO". If the surgeon believes that the cause for hysterectomy may endanger the ovaries as well, you will be offered a BSO together with the hysterectomy.
It is important to ensure that the surgeon will not take the ovaries out only because it is convenient to him or her to do while you are already on the table. Taking the ovaries out will put you in the state of surgical menopause, meaning you will lack certain hormones for the rest of your life. It turns you into a perpetual customer for hormone replacements, so make it a joint decision before the surgery.
Type of Hysterectomy According to How the Uterus Is Removed
Vaginal hysterectomy is removing the uterus through the vagina. The presence of large uterine fibroids, large ovarian cysts, extensive endometriosis, or unexplained pelvic pain may stand in way of vaginal hysterectomy. But when it can be can safely be performed, vaginal hysterectomy generally involves fewer complications, a shorter recovery period and no visible scar.
Abdominal hysterectomy is removing the uterus through an incision in the abdomen. This is still the most common type of hysterectomy.
Total abdominal hysterectomy (or TAH), is removing the uterus with the cervix through the abdomen.
Laparoscopic hysterectomy (or LH) is perfoming the entire (or most of the) hysterectomy through the laparoscope.
Laparoscopically assisted vaginal hysterectomy (or LAVH) is using laparascope and completing the hysterectomy through the vagina.
Laparoscopic supracervical hysterectomy (or LSH) is a relatively new procedure, from the mid 1990's. It cuts away the body of the uterus, but leaves the cervix in place. Many say that this is the future of hysterectomy, so if you must have it, at least ask whether it is available in the operating "theatre near you"!?
Choosing the Right Type of Hysterectomy -- Is TAH Better Than LH?
Given enough time to operate, laparoscopy is better. The incisions are smaller and in case of LAVH, there are no abdominal incisions at all. However, there are no hard data showing the LAVH is superior the TAH, provided, of course, that both types of operation can be done safely.
Laparoscopy is clearly better then classical surgery for gallbladder and ovarian cysts, since most of the problems the patient has comes from the incision and not from what is done in the inside. Hysterectomy is different in that regard, since the tissues around the uterus must heal as well. Although this means that the difference between a laparoscopic and classical hysterectomy is not that great after all, if possible, opt for laparoscopy.
Think Twice Before Deciding for the Type of Hysterectomy
Some types of hysterectomies involve removing other organs as well. There are several ways to classify a hysterectomy so discuss with your doctor the kind of hysterectomy recommended to you. If something rings false talking to the first doctor, ask for a second opinion. Be peristent and open yourself to learning new things and notions. Otherwise, why do you think your situation can change for the better if you continue with your old, bad ways!?
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