(TLH) A New Approach to Hysterectomies

The total laparoscopic hysterectomy (TLH) offers women an option that is far less invasive than other surgical approaches. The need for a hysterectomy is an important and difficult decision.

The surgical removal of the uterus can be lifesaving for those suffering from gynecological cancers or the severe pain and heavy bleeding due to fibroids or endometriosis.

The days of “one hysterectomy fits all” have long passed. Today, there are several types of approaches, many of which are far less invasive than the “open” or abdominal hysterectomies (TAH) still widely performed. This is due to the laparoscope - a slender, fiber-optic tube equipped with a miniature camera, lights and surgical instruments. It allows visualization inside the abdomen and technical access to the uterus, ovaries and fallopian tubes without having to make a large incision.

In the past few years, many gynecologists have performed a portion of the hysterectomy using a laparoscope. Called a laparoscopically assisted vaginal hysterectomy (LAVH), the procedure requires an incision deep within the vagina, through which the uterus and related organs are removed. The LAVH still involved a transvaginal approach and increased healing time, similar to a total vaginal hysterectomy (TVH)

Now with advanced laparoscopic skills, gynecological surgeons are performing entire hysterectomies using a laparoscope. This is called a total laparoscopic hysterectomy (TLH). The operation is performed completely through four tiny abdominal incisions less than one-quarter to one half an inch in length. Even a large uterus can be removed laparoscopically from a woman even if she has never had children.

TLH patients usually go home the same day or stay overnight in the hospital and are often back to a normal routine in one to two weeks. They report less pain, minimal narcotic pain medication use after surgery and a faster recovery time than women undergoing abdominal hysterectomies. A traditional open hysterectomy requires an abdominal incision of four to eight inches and a hospital stay of three to four days, and recovery usually takes 6 to 8 weeks.

Performing entire hysterectomies using laparoscopic techniques demands state-of-the-art surgical skills, hospital equipment and years of experience. The majority of hysterectomies are performed for benign tumors or conditions that allows women a choice of a variety of alternative treatments for fibroids, endometriosis and uterine prolapse. A hysterectomy should be the choice only when all other treatments have failed.

Our practice is open to a consultation regarding alternatives to hysterectomies as well as to different types of hysterectomies that may be an option for your specific condition.