Total Laparoscopic Hysterectomy (TLH)
Total Laparoscopic Hysterectomy (TLH) requires general anesthesia and vaginal and laparoscopic incisions to remove the uterus and cervix. The important difference is that in TLH vaginal retractors are not needed since the vagina is closed by suturing from inside the pelvic cavity under direct vision of the laparoscope (camera). This procedure is technically more difficult than TAH, TVH, LAVH, and LSH since it requires the surgeon to be trained in advanced laparoscopy. Special energy sources are used to seal and divide the blood vessels and to detach the uterus from its attachments. If the uterus in small, it is removed through the vagina. If the uterus is large, a special device called a morcellator is used to cut the uterus into small strips so it can be removed through the 12mm laparoscopic port/incision site. Usually, TLH is an outpatient surgery and patients usually go home six to eight hours after surgery. Post-operative recovery is normally two-three weeks and patients can usually resume intercourse after six weeks.
The benefits of laparoscopic surgery are many. To name a few, patients usually go home the same day, the recovery time is faster and less painful, and the cosmetic outcome is better. At AMIGS, we are trained in advanced laparoscopy and perform the overwhelming majority of our cases laparoscopically, even in patients that have a very large uterus or have had multiple abdominal surgeries in the past. We feel that the minimally invasive laparoscopic approach to removing the uterus is the best approach for the patient.
Laparoscopic Supracervical Hysterectomy (LSH)
Laparoscopic Supracervical Hysterectomy (LSH) requires general anesthesia and only laparoscopic incisions to remove the uterus. The cervix is spared thus there is no vaginal incision needed. LSH procedure is essentially sutureless and bloodless since special energy sources are used to seal and divide the blood vessels and to detach the uterus from the cervix and the ovaries. The uterus is removed using a morcellator through the belly button (umbilical) port/incision site. Having performed over 1500 Laparoscopic Supracervical Hysterectomy (LSH) procedures, Dr. Mordel notes that LSH avoids unpleasant scars and shortening the vagina, eliminates the need for retractors and bowel packing, and significantly reduces hospital stays, postoperative pain and recovery time. Laparoscopic Supracervical Hysterectomy (LSH) generates less pain than any other hysterectomy. It is usually an outpatient procedure and patients usually go home six to eight hours after surgery and return to normal activities in about two weeks. Preservation of the cervix maintains the integrity of the vagina so it does not become shortened. It also saves some of the blood supply and nerve network and therefore may preserve pelvic floor function, including sexual response. However this is not proven in the literature. After having a procedure where the cervix is spared, a patient will need to have routine Pap Tests per ACOG guidelines since the risk of cervical cancer still exists. Also we like to make patients aware that there is a very small possibility that occasional light vaginal spotting from the cervix can occur.