* A Hysterectomy? What Kind?

I understand there are different kinds of hysterectomy surgeries. What are they and how are they different?


Abdominal Hysterectomy

Often called a “total” and abbreviated to TAH– this is the removal of the uterus and the cervix because together they form the entire uterus. A SAH, is a supracervical abdominal hysterectomy which means that only the main part of the uterus is removed, and the cervix is left in place.

The doctor makes a cut in the abdominal wall to expose the ligaments and blood vessels around the uterus. The muscles in the abdomen are usually not cut, but spread apart with retractors. The ligaments and blood vessels are separated from the uterus and the blood vessels tied off so they will heal and not bleed. Then, the uterus with the cervix, is removed by cutting it off at the top of the vagina. The top of the vagina is repaired by being sewn so that a hole is not left. This is called the vaginal cuff.


Vaginal Hysterectomy

In this procedure, called total vaginal hysterectomy (TVH) the procedure is the same as in the TAH, but rather than having an abdominal incision the doctor removes the uterus and cervix through a cut in the vagina.

As with the TAH the top of the vagina is repaired by being sewn to form the vaginal cuff. Not all women are able to have this kind of surgery – it depends on many factors (such as the size of the uterus) and the doctor will have to be the judge of whether or not this surgery is right for any individual patient.

Laparoscopic Hysterectomy

There are 2 kinds of Laparoscopic Hysterectomies – LAVH AND LSH

LAVH stands for Laparoscopically Assisted Vaginal Hysterectomy. During a LAVH, several small cuts are made in the abdominal wall through which slender metal tubes called "trocars" are inserted to provide access for a laparoscope and other small surgical instruments. The laparoscope is like a tiny telescope with a camera attached to that provides a continuous image which is enlarged and projected onto a television screen.

Just like in a TAH or TVH, the uterus (including the cervix) is detached from the ligaments that attach it to other structures in the pelvis, and removed through a cut at the top of the vagina which is repaired with stitches.

An LSH is a supracervical laparoscopic hysterectomy and is done the same way as a LAVH, but does not remove the cervix. The uterus is cut up into small pieces and removed through the tubes which were inserted into the abdomen.

Again not all women are candidates for laparoscopic hysterectomies and the decision to use this method must be made on an individual basis.

BSO – Bilateral Salpingo oophorectomy

Sometimes, both ovaries and fallopian tubes are removed at the same time a hysterectomy is done. When both ovaries and both tubes are removed, it is called a bilateral salpingo-oophorectomy which is usually shortened to BSO. (bilateral=both sides, salpingo =the fallopian tubes, oophore =the ovaries, ectomy = removal)

Sometimes only the left or right ovary & tube are removed, and this is referred to as RSO or LSO .