Hysterectomy Alternatives

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Laparoscopic Hysterectomy, (total or partial) is a laparoscopic procedure for removing the uterus through small abdominal incisions. The entire uterus can be removed (TLH, total laparoscopic hysterectomy) or the cervix can be left in place (LSH, laparoscopic supracervical hysterectomy). With both procedures the ovaries can be removed if needed or desired without additional incisions. Laparoscopic hysterectomies are done under general anesthesia and many times as outpatient. The recovery is from 1-3 wks, with restriction on vaginal intercourse for 6 wks in TLH cases.

Endometrial Ablation is a minimally invasive procedure to treat heavy menstrual bleeding done with minimal anesthesia, occasionally in office setting. The procedure involves the use of energy to destroy the endometrium ( lining of uterus) which is responsible for menstrual bleeding. Several different devices using different energy modalities exist to accomplish reduction in menstrual flow or in many cases complete cessation of menses (amenorrhea). Novasure ablation uses a device inserted into the uterus through the cervix and applies heat energy for approximately 90 seconds to achieve the destruction of the endometrium leading to reduction of menstrual flow.

Laparoscopic Myomectomy is the removal of fibroid tumors from the uterus using laparoscopic techniques avoiding a large “open” incision. The use of special instrumentation allows this minimally invasive procedure to preserve the uterus. It is usually performed for abnormal menstrual bleeding, pain or infertility or in cases where hysterectomy is not desired. This procedure requires extensive advanced laparoscopic skills and can be done in an outpatient setting.

Hysteroscopic Myomectomy is the removal of fibroid tumors with the use of the hysteroscope allowing resection of fibroids that protrude into the cavity of the uterus. This approach does not involve abdominal incisions and is done through the vagina. Occasionally it is performed in conjunction with a laparoscopic myomectomy for removal of larger fibroids usually to treat abnormal menstrual bleeding or infertility. It can be done on an outpatient basis.


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