Laparoscopic Hysterectomy

Laparoscopic hysterectomy was first decribed in the 1980s by Professor Kurt Semm
of the University of Keil, Germany. Before then all hysterectomies were either
open or abdominal

The first successful hysterectomy in the United States ocurred in 1853 by a Dr.
Walter Burnham of Massachusetts. At the time, Dr. Burnham was removing what he
thought was an ovarian cyst when the patient suddenly vomited and pushed the uterus
through the abdominal incision. He was forced to perform a hysterectomy because he
was unable to return the uterus to the abdomen. The patient survived and made a
full recovery. His success encouraged him to try the operation again. Of the next
15 cases on 3 patients survived. These hysterectomies were performed without the
benefit of anesthesia or aseptic technique.

The development of Chloroform and Ether anesthesia and techniques for sterilizing
instruments soon became available. In 1890 the first surgical gloves were
manufactured by the Goodyear Rubber Company.

Laparoscopy was first described in 1911. The abdominal organs were viewed through
a small scope using reflected light. Scopes with little light bulbs on the end
became available in the mid 20th century. These bulbs were so hot that a severe
burn occurred any time they came in contact with an internal organ. Fiber optic
technology, which came along in the 1970s, made laparoscopy much safer and more
feasible. Video cameras for laparoscopy were developed in the 1980s and allowed
everyone in the OR to now see what was going on inside and ushered in the modern
era of operative laparoscopy.

Dr. Semm was extremely innovative in the field of operative laparoscopy. He
described techniques for laparoscopic myomectomy(removing fibroids without
hysterectomy), hysterectomy, removal of ovaries and ovarian cysts. As is the case
with many revolutionary advances Dr. Semm was ridiculed and persecuted by his peers
who instantly rejected his ideas. At one point he was forced to submit to a
psychological exam to prove he was not crazy. He persevered and now has an annual
award given in his honor by the American Association of Gynecologic Laparoscopists
for excellence in laparoscopic pelvic surgery.

There are numerous terms used by physicians to describe hysterectomy. These can be
confusing to a patient. Many times initials may be used instead of more exact
wording. For the patient it is important to extract an exact definition from the
doctor regarding the hysterectomy being considered.

A patient may feel intimidated by the whole process. However, the woman is the
one undergoing the surgery, so it is extremely important to ask several defining
questions before submitting to hysterectomy.

The answer to the first question may include several terms that require definition.

A total abdominal hysterectomy, or TAH, refers to an open hysterectomy with removal
pf the cervix. When the doctor uses this term or the initials it is important
for the patient to ask about the ovaries because it is non specific. One doctor
may use TAH to refer to a hysterectomy without removing the ovaries, whereas
doctor will use this term and intends to remove the ovaries. So it is important
to ask about the ovaries.

A sub-total hysterectomy is a term with several possible meanings. It may refer
to a vaginal hysterectomy without removal of ovaries, an open abdominal
hysterectomy without removal of ovaries, or a supracervical hysterectomy. So it
becomes necessary to ask the question about exactly what does the doctor mean by
this term. Will the ovaries be left, will the cervix remain or be removed, and is
is it an open, vaginal or laparoscopic operation.

A vaginal hysterectomy is also referred to as a TVH(total vaginal hysterectomy).
Again it is important to ask about the ovaries becuase two different doctors may
use the same term but have different plans for the ovaries. With rare exception
the cervix is removed when a vaginal hysterectomy is performed.

There are a host of terms and initials to describe laparoscopic hysterectomies.
LAVH stands for laparoscopic assisted vaginal hysterectomy. In this operation
part of the procedure is performed laparoscopically and then completed like a
vaginal hysterectomy. The cervix is removed in an LAVH. Again, it is important
to ask about the ovaries when discussing LAVH.

Total laparoscopic hysterectomy is called THL. The entire hysterectomy is
performed laparoscopically and the cervix is removed. You will want to address
what will happen with the ovaries.

A laparoscopic supracervical hysterectomy(LSH) is performed laparoscopically. The
cervix is left in place. The ovaries should be clarified. A supracervical
hysterectomy can be performed open as well, so it is important to make sure what
the doctor means when they say supracervical, is it open or laparoscopic?

The term laparoscopic hysterectomy could mean any of the above. The doctor could
use laparoscopic hysterectomy to mean LAVH, THL, or LSH. So, it again becomes
very important for the patient to inquire about the specifics of the operation.

Another form of laparoscopic hysterectomy is the laparoscopic intrafacial
hysterectomy(LIH), it may also be called a classic intrafacial supracervical
hysterectomy(CISH). In this procedure the cervical canal is removed, but not the
whole cervix. The ovaries need to be discussed separately from the uterus.

The is a difference in recovery for different forms of hysterectomy. In the
medical literature most studies report women take 6 weeks off work after an open
abdominal hysterectomy and 4 weeks off after a vaginal hysterectomy or LAVH.

LSH and LIH boast significantly fast recovery than all other forms of hysterectomy.
In two separate, independent, reviews of the Advanced Women’s Health Institute
database the average patient return to work in 10 days. Some women have reported
going back to work part time as early as 4 days after surgery. Full recovery was
reported on average to be 3 weeks.

The other extremely important questions to ask the doctor is about their training.
This may be difficult because a patient may be concerned about offending the
physician. It is okay to ask how many of the proposed operation they have done.
Have they presented a paper or given a talk to other doctors on the subject.
Would it be okay to talk to another patient who went through the same procedure.
If the doctor acts offended that may be a clue to seek out a second opinion.

Another clue to deciding if this is the right surgeon has to do with their
recommendation. If the doctor says an open abdominal hysterectomy is necessary
becuase of the size of the uterus they probably are not trained enough and you
should seek out a second opinion.