Hysterectomy

Question 1

List some indications for hysterectomy

Answer 1

Uterine leiomyoma/fibroma, abnormal uterine bleeding, pelvic organ prolapse, pelvic pain, infection, malignant or premalignant disease, OB hemorrhage, gender affirmation

Question 2

What is a TAH

Answer 2

total abdominal hysterectomy

Question 3

What is a TVH

Answer 3

total vaginal hysterectomy (least invasive)

Question 4

What is a LAVH

Answer 4

laparoscopic assisted vaginal hysterectomy

Question 5

What is a TLH

Answer 5

total laparoscopic hysterectomy (MC procedure)

Question 6

What is a SCH

Answer 6

supracervical hysterectomy (subtotal) (usually requires morcellating the uterus/specimen)

Question 7

What is a total hysterectomy

Answer 7

removal of uterus and cervix (Radical includes lymph nodes/parametrium, typically done in cancer cases)

Question 8

Describe a supracervical hysterectomy

Answer 8

removal of uterus ABOVE & NOT INCLUDING the cervix

Question 9

Describe when to avoid a laparoscopic approach to a hysterectomy

Answer 9

• pts with significant cardiopulmonary disease (steep trendelenburg)
• suspicion of malignancy/premalignancy
• default to abdominal when medically complex or with higher odds of complications

Question 10

Why is cystoscopy done in hysterectomy procedures

Answer 10

to ensure intact bladder & efflux from ureters (no damage from hysterectomy procedure)

Question 11

Describe the post-op expectations for different hysterectomy procedures

Answer 11

Vaginal & laparoscopic: d/c same day or next day, return to activity in 1-2 weeks

Abdominal: d/c in 1-3 days, return to activity in 4-6 weeks

Lifting restrictions of 20 lbs, no significant exercise, pelvic rest, varying time off work