Hysterectomy is the term used to describe the surgical removal of all or part of the uterus and cervix. It may or may not include the removal of the ovaries and tubes.
It can be surgically approached via different routes as listed below in decreasing order of preferability/less invasiveness/quicker return to normalcy.
1. Vaginal Hysterectomy (TVH): Involves accessing and removing the cervix and uterus through the vagina. This is the best preferred method.
2. Laparoscopic hysterectomy: May be total or supracervical and includes:
- Traditional laparoscopic hysterectomy
- Robotic assisted laparoscopic hysterectomy
Involves accessing the uterus through small incisions on the abdominal wall and using specialize instruments passing through these miniature incisions to get to the pelvis. The abdomen is usually inflated with CO2 enabling the surgeon to work safely in an air filled space. This method is the second preferred method.
3. Abdominal/Open: An abdominal incision—either bikini type or up and down type—is used to gain entrance into the abdominal cavity an access the uterus. It is the most invasive. This, however, may be the preferred type in certain circumstances (e.g., extremely large uterus, extensive intrapelvic scarification from previous multiple surgeries, or being done during another open procedure—for instance, at the time of C/S or surgery being performed for advanced cancer.
Neuromodulation is a clinically proven, FDA approved (since 1997) therapy for management of Refractory OAB (Overactive Bladder), Incomplete Bladder Emptying (not due to outflow obstruction), and Fecal Incontinence (the latest since March 2011).