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Hysterectomies: Abdominal Hysterectomies
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In laparoscopic hysterectomies, the uterus is removed either vaginally or through small incisions made in the abdomen. The surgeon can see the target anatomy on a standard 2D video monitor thanks to a miniaturized camera, inserted into the abdomen through the small incisions. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy alone.
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A new study has found that laparoscopic-assisted radical vaginal hysterectomies (LARVH) are as effective as the more commonly accepted radical abdominal hysterectomy for the treatment of early-stage cervical cancer. The benefit of LARVH includes decreased blood loss during surgery, better cosmetic results due to the smaller incisions, faster recovery time and a shorter hospital stay.
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Of more than 538,000 hysterectomies performed for benign disease in 2003, 66.1 percent were abdominal hysterectomies, in a large abdominal incision is made to remove the uterus. Another 21.8 percent were vaginal, in which the uterus is extracted entirely through the vagina, leaving no scars. And finally, 11.8 percent done by laparoscopy, which is conducted by inserting one or more small plastic tubes through tiny incisions made in the abdominal wall, allowing narrow surgical instruments and a tiny camera to pass through to remove the uterus.
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A large study compared different types of hysterectomies. They compared laparoscopic with abdominal hysterectomy and laparoscopic with vaginal hysterectomy. One of their findings was that laparoscopic hysterectomy was associated with a significantly higher rate of major complications than abdominal hysterectomy.
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Demographically, the number of hysterectomies performed each year in the U.S. has declined for several years. But as the overall number of abdominal hysterectomies has fallen, a specific type of abdominal hysterectomy has steadily gained popularity in the meantime. Dr. E. Scott Sills and colleagues at Cornell Medical Center in Manhattan found that supracervical (or "sub-total") hysterectomies done in the U.S. increased by an impressive 250% from 1991 to 1994.
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Traditionally, vaginal hysterectomies have been the procedure of choice for women with uterine weights up to 280 g when benign disease is confined to the uterus. Although there were differences in mean uterine weights in this study for each route, the higher weights (23.7 g for abdominal hysterectomies and 8 g for laparoscopically assisted vaginal hysterectomies) do not represent technical challenges that would mandate a particular route.
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Abdominal Hysterectomies