Laparoscopic Methods for Hysterectomy

Laparoscopic Supracervical Hysterectomy (LSH)

Dr. Garcia specializes in the LSH procedure and has received additional surgical training in order to perform this surgery.  She is the only surgeon in New Mexico currently performing the LSH procedure who is fellowship trained in minimally invasive surgery for women and has the expertise needed to perform this procedure more safely. 

This surgical technique involves general anesthesia and uses laparoscopy alone to remove the uterus, but leaves the cervix attached to the vagina.  Many gynecologic problems involving the uterus are localized to the top of the uterus and there is no need to remove the cervix or ovaries.   During the LSH procedure, a laparoscope (thin lighted telescope) and small surgical instruments are inserted through tiny incisions in the navel and abdomen. Using these instruments, the surgeon is able to carefully separate the uterus from the cervix and then remove it through one of the small incisions. A surgical instrument called a morcellator makes it possible to remove the uterus in small pieces through one of the tiny incicisions.  

The LSH was developed to reduce pain and surgical trauma, minimize scarring and shorten recovery time.  There are fewer complications with the LSH when compared to other hysterectomy approaches if the surgeon has been appropriately trained.  Not all surgeons however, have the experience or training to perform the LSH.  It is important to ask how many of these procedures your surgeon has performed and how specialized training for the LSH was obtained.

The procedure can be performed on an outpatient basis. Most women are home within 1 day or less and return to normal activity including intercourse is usually about fourteen days. Because the cervix is left in place, a woman should be willing to get regular Pap smears to screen for cervical cancer. Leaving the cervix requires that a woman has adequate support to the top of her vagina. Such support may be altered during vaginal childbirth or be unchanged if a woman has never been pregnant or never delivered vaginally. Maintaining the vaginal support by leaving the cervix intact may help to decrease the chance of urinary incontinence and vaginal vault prolapse (falling down) which can occur following removal of the cervix.  This approach may not be appropriate for extremely large fibroids. 

Total Laparoscopic Hysterectomy (TLH)

This procedure also involves general anesthesia and removes the uterus and cervix with the laparoscope.  Unlike the laparoscopic assisted vaginal hysterectomy (LAVH) procedure in which part of the surgery is performed through the vagina, the TLH is performed entirely with the laparoscope.  As with the LAVH, this procedure is usually performed when use of the laparoscope facilitates removal of the uterus and cervix such as when a woman has had prior abdominal surgery, or endometriosis that may have caused adhesions (internal scar tissue) or when definite removal of the ovaries is desired.  Advantages of this approach over the LAVH involve better visualization of anatomy with use of the camera.  Hospital stay and recovery are similiar to the LAVH procedure. 

The TLH requires additional surgical skill and training compared to the LAVH procedure.

Laparoscopic Assisted Vaginal Hysterectomy (LAVH)

This technique is similar to the total vaginal hysterectomy but requires additional surgical skills and instruments. A laparoscope is used to facillitate removal of the uterus and cervix through the vagina.  This surgery is usually performed under general anesthesia and hospital stay and recovery time is similar to the vaginal hysterectomy.