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Hysterectomy - LSH / TLH

Hysterectomy is the surgical removal of the uterus. It is a very common procedure that is done either through the abdomen or vagina. A vaginal hysterectomy can also be done with the assistance of laparoscopy. The ovaries and tubes may or may not be removed at the same time. Common indications for a hysterectomy include bleeding, pain, uterine prolapse, and fibroids. Hysterectomy may be recommended for women with fibroid tumors. Each year in the U.S. alone, doctors perform approximately 600,000 hysterectomies, making it the second most common surgical procedure for women. In fact, 1 in 3 women will have a hysterectomy before age 60.

Approaches to Hysterectomy
Open Hysterectomy
-Dr. Erhard performs the majority of hysterectomies using an open approach. With open surgery, she makes a large abdominal incision large enough to fit her hands and instruments inside your body. While open surgery allows Dr Erhard to see and touch your organs, there are some drawbacks for patients due to the large incision. 

Minimally Invasive Hysterectomy Options


Vaginal Hysterectomy
-With vaginal hysterectomy, the uterus is removed through the vagina, without any external incision. Dr. Erhard may use this minimally invasive approach if the patient’s condition is benign (non-cancerous) or when the uterus is a normal size and the condition is limited to the uterus. With vaginal hysterectomy, Dr. Erhard has a small working space and lack of view to the pelvic organs.

Laparoscopic Hysterectomy
- Laparoscopic surgery is minimally invasive meaning Dr. Erhard operates through a few small incisions. During traditional laparoscopy, long-handled surgical instruments are inserted through the incisions. One of the instruments is a laparoscope - a thin, lighted tube with a tiny camera at the end. The camera takes images inside your body and those images are sent to a video monitor to guide surgeons as they operate.

TLH (Total Laparscopic Hysterectomy)
- Total Laparoscopic Hysterectomy is also an outpatient minimally invasive surgical procedure that removes both the uterus and cervix. Examples of indications for removal of the cervix would include any abnormalities of the cervix, a history of abnormal Pap smears, bleeding that involves the cervix or any pathological condition that may extend to the cervix. TLH is typically performed in a Same Day Surgery Center in less than one hour. Small incisions are made at the umbilicus and in the lower abdomen where special laparoscopic instruments are used to perform the surgery. Special sutures are placed at the top of the vagina where the cervix and uterus were removed. Most patients go home the same day as surgery and recover in 7-14 days. Patients are advised to avoid intercourse for 6 weeks during the time that the vagina is healing and the stitches are dissolving

LSH (Laparoscopic Supracervical Hysterectomy)
- Laparoscopic Supracervical Hysterectomy is an outpatient minimally invasive surgical procedure that removes the uterus and retains the cervix. The uterus is responsible for our menstrual periods  Examples of indications for LSH include abnormal or dysfunctional bleeding, persistent irregular bleeding and fibroids unresponsive to conservative medical management. LSH is recommended when a patient has an indication for a hysterectomy such as severe uncontrolled menstrual bleeding, but her cervix is healthy. Research has demonstrated a decreased incidence of pelvic organ prolapse and sexual dysfunction by retaining the cervix. LSH is performed in an outpatient Same Day Surgery Center in less than one hour. Small incisions are made at the umbilicus and in the lower abdomen where special instruments are used to perform the surgery laparoscopically or through a scope. Most patients go home the same day as surgery and recover in 7-10 days including resuming exercise and intercourse.
Types of Hysterectomy

There are many types of hysterectomies that are performed, depending on the patient’s diagnosis. All hysterectomies involve removal of the uterus. What can vary are which additional reproductive organs and other tissues that may be removed. Types of hysterectomy include:

Partial or Subtotal Hysterectomy
- This procedure, also known as a supracervical hysterectomy, involves removing the uterus but leaves the cervix intact. This decision is often based upon patient preference.

Removal of Lymph Nodes
- For hysterectomies performed for malignant conditions - such as uterine, cervical, or ovarian cancer - Dr. Erhard will also remove certain lymph nodes. This procedure is often referred to as a lymph node dissection or lymphadenectomy. Lymph nodes will be removed in certain areas, depending upon the location and extent of the disease. Lymph node removal also helps Dr. Erhard determine the extent or stage of your cancer and can guide further adjuvant treatment, such as radiation therapy or chemotherapy.

Removal of the Fallopian Tubes and Ovaries
- These organs may or may not be removed during your hysterectomy procedure. This will depend upon your condition, age and other factors. Often, the ovaries and fallopian tubes are left intact. Removal of the ovaries is called an oophorectomy. Removal of fallopian tubes and ovaries is called a salpingo-oophorectomy.

Radical Hysterectomy
- For this procedure the uterus and cervix are removed.

Total Hysterectomy
- This procedure is most often performed for cervical cancer and involves removal of the uterus, tissues next to the uterus, the upper part (about 1 inch) of the vagina and pelvic lymph nodes. The fallopian tubes and ovaries may also be removed. This procedure involves removing the uterus and the cervix. The vagina remains entirely intact. This is the most common type of hysterectomy