A hysterectomy is a common gynecological procedure involving the surgical removal of the uterus. This operation is frequently recommended for treating conditions such as symptomatic uterine fibroids, persistent abnormal bleeding, or certain pelvic organ disorders. Advancements in surgical techniques led to the development of the Total Laparoscopic Hysterectomy (TLH), a modern, minimally invasive approach. TLH achieves the same medical outcome as traditional surgery but uses smaller incisions, allowing for faster recovery.
The Essential Components of a Total Hysterectomy
A total hysterectomy, regardless of the surgical method used, requires the removal of two specific reproductive structures. The primary organ removed is the uterus, the muscular, pear-shaped organ where a fetus develops during pregnancy. Its removal halts menstrual cycles and ends the possibility of future pregnancy.
The second structure removed for the procedure to be designated as “total” is the cervix. The cervix is the lower, narrower portion of the uterus that connects to the top of the vagina. It serves as a physical barrier and regulates the flow of menstrual blood and sperm.
Removing the cervix eliminates the risk of developing cervical cancer, meaning routine cervical screening tests, such as Pap smears, are generally no longer required. The surgeon detaches both the uterus and cervix from the surrounding ligaments and blood vessels before extraction.
Defining “Total” vs. “Subtotal” Hysterectomy
The difference between a “total” and a “subtotal” hysterectomy hinges entirely on the fate of the cervix.
A subtotal hysterectomy, sometimes called a supracervical hysterectomy, involves removing only the main body of the uterus. The cervix is intentionally left intact and remains in its anatomical position.
Patients who undergo a subtotal procedure must continue routine cervical screenings, as the tissue where cancer can originate is still present. Some individuals may also experience light, cyclical bleeding because the remaining cervical lining can respond to hormonal fluctuations.
Optional Removals: Ovaries and Fallopian Tubes
Many people confuse the scope of a total hysterectomy with the removal of surrounding organs, specifically the ovaries and fallopian tubes. The definition of a total hysterectomy does not automatically include these structures. Their removal is a separate, often simultaneous, surgical decision.
The surgical term for the removal of the fallopian tubes is a salpingectomy. The fallopian tubes are slender ducts that transport eggs from the ovaries to the uterus. Increasingly, a bilateral salpingectomy, which removes both tubes, is performed during a hysterectomy to reduce the long-term risk of developing ovarian cancer.
The surgical removal of one or both ovaries is called an oophorectomy. The ovaries are small, almond-shaped glands that produce hormones, including estrogen and progesterone, and release eggs. When a hysterectomy involves the removal of both the ovaries and the fallopian tubes, the combined procedure is termed a bilateral salpingo-oophorectomy.
If a patient who has not yet experienced menopause undergoes a bilateral oophorectomy, the immediate cessation of hormone production will trigger surgical menopause. Therefore, the decision to remove the ovaries is complex, involving careful consideration of age, cancer risk, and the consequences of sudden hormonal changes.
The Laparoscopic Method: How the Removal Occurs
The “laparoscopic” part of the procedure title refers to the technique used to access and remove the organs, often called keyhole surgery. This minimally invasive method uses several small incisions, typically three to five, each measuring less than one centimeter, across the lower abdomen. Specialized surgical instruments are inserted through these tiny openings.
The primary tool is the laparoscope, which is a thin, lighted tube equipped with a small video camera. This camera transmits a high-definition image of the internal pelvic cavity to a monitor, allowing the surgeon to visualize the procedure without needing a large abdominal incision. The surgeon uses long, delicate instruments to carefully detach the uterus and cervix from the surrounding tissues.
Once the uterus and cervix are fully detached, they are typically removed from the body through the vagina. Alternatively, if the uterus is particularly large, it may be divided into smaller pieces, a process called morcellation, and removed through one of the small abdominal incisions. The small incisions are then closed with sutures or surgical glue, resulting in much smaller scars and a notably shorter recovery period compared to traditional open surgery.