LYCOS RETRIEVER 
Hysterectomies: Abdominal Hysterectomies
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The hysterectomies can be performed with traditional total, subtotal, intrafascial, vaginal or laparoscopic approach. Total abdominal hysterectomy is the standard of care today. In the vast majority of the hysterectomies performed, there is no need for removal of the cervix... total hysterectomy is performed as standard of care for the prevention of future cervical cancer and menstrual bleeding. Subtotal Hysterectomy is mostly performed for difficult surgical cases and is criticized for future risk of carcinoma of cervical stump and cost of its preventive care. For removal of cervical canal and T-Zone, many physicians have tried intrafacial hysterectomy or performed supracervical hysterectomy and tried to destroy the cervical canal using electrocautery needle or cone biopsy electrode. However the procedures are never uniform and results are variable.
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A new report reveals that more than 60 percent of doctors rarely or never discuss the differences between total and subtotal hysterectomies with their patients. The study, published in the August issue of the journal Obstetrics and Gynecology, relied on a survey of doctors in the Washington, DC area. In total hysterectomies, the entire uterus and cervix is removed through a major abdominal incision; in subtotal hysterectomies, the cervix remains intact and the uterus is usually removed through the vagina, according to Gannett News Service.
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The present survey comprising 10110 hysterectomies was performed at the time when laparoscopic hysterectomy and vaginal hysterectomy were progressively replacing the traditional abdominal hysterectomy (Figure 1). The operations were performed by >100 operators from 58 hospitals. The majority of the procedures were total hysterectomies; but 11.6% of the abdominal hysterectomies and 2.1% of the laparoscopic hysterectomies were subtotal. The number and rate of the different types of hysterectomies by hospital level are shown in Figure 2.
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Laparoscopic-assisted radical vaginal hysterectomies have been performed in Canada for less than ten years, while radical abdominal hysterectomies have been used for more than one hundred years. Covens notes that moving toward the use of laparoscopic technique would be a fundamental change from current practice. The one drawback to the laparoscopic-assisted option may be a longer delay in the return of normal bladder function, which Covens anticipates will be improved as surgeons gain more experience.
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Surgeons perform the majority of hysterectomies using an “open” approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6-12 inch incision. When cancer is involved, the conventional treatment has always been open surgery using a large abdominal incision, in order to see and, if necessary, remove related structures like the cervix or the ovaries.
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After surgery, a woman will feel some degree of discomfort; this is generally greatest in abdominal hysterectomies because of the incision. Hospital stays vary from about two days (laparoscopic-assisted vaginal hysterectomy) to five or six days (abdominal hysterectomy with bilateral salpingo-oophorectomy). During the hospital stay, the doctor will probably order more blood tests.
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Abdominal Hysterectomies