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- What is a hysterectomy?
- How common is hysterectomy?
- Why is a hysterectomy performed?
- What tests or treatments are performed prior to a hysterectomy?
- How is a hysterectomy performed?
- What are the types of hysterectomies?
- Total abdominal hysterectomy
- Vaginal hysterectomy
- Laparoscopy-assisted vaginal hysterectomy
- Supracervical hysterectomy
- Laparoscopic supra cervical hysterectomy
- Radical hysterectomy
- Oophorectomy and salpingo-oophorectomy (removal of the ovaries or Fallopian tubes)
- What are complications of a hysterectomy?
- What are the alternatives to a hysterectomy?
- Should women who have had a hysterectomy continue to have Pap smears?
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Laparoscopy-assisted vaginal hysterectomy
Laparoscopy-assisted vaginal hysterectomy (LAVH) is similar to the vaginal hysterectomy procedure described above, but it adds the use of a laparoscope. A laparoscope is a very thin viewing tube used to visualize structures within the abdomen. Certain women would be best served by having laparoscopy used during vaginal hysterectomy because it allows the upper abdomen to be carefully inspected during surgery. Examples of uses of the laparoscope would be for early endometrial cancer (to verify lack of spread of cancer), or if oophorectomy (removal of the ovaries) is planned. Just as with simple vaginal hysterectomy without a laparoscope, the uterus must not be excessively large. The physician will also review the medical situation to be sure there are no special risks prohibiting use of the procedure, such as prior surgery that could have increased the risk for abnormal scarring (adhesions). If a woman has such a history of prior surgery, or if she has a large pelvic mass, a regular abdominal hysterectomy might be considered.
A supracervical hysterectomy is used to remove the uterus while sparing the cervix, leaving it as a "stump." The cervix is the area that forms the very bottom of the uterus, and sits at the very end (top) of the vaginal canal (see illustration above). The procedure probably does not totally rule out the possibility of developing cancer in this remnant "stump." Women who have had abnormal Pap smears or cervical cancer clearly are not appropriate candidates for this procedure. Other women may be able to have the procedure if there is no reason to have the cervix removed. In some cases the cervix is actually better left in place, such as some cases of severe endometriosis. It is a simpler procedure and requires less time to perform. It may give some added support of the vagina, decreasing the risk for the development of protrusion of the vaginal contents through the vaginal opening (vaginal prolapse).