Total Laparoscopic Hysterectomy

Total Laparoscopic Hysterectomy (TLH) offers substantially less pain and recovery. TLH has significantly less cost and uses only 3 incisions, which are less than 2 cm when added together, instead of 5 incisions totaling almost 5 cm that are required in a robotic assisted hysterectomy.

What is a Hysterectomy?

A hysterectomy is an operation to remove your uterus. It is one of the most common operations in the United States with over 500,000 performed each year. In fact, for women it is the second most common surgery in the United States after cesarean sections.

Reasons for Performing a Hysterectomy:

There are many reasons for performing a hysterectomy. Some of the more common reasons for a hysterectomy are:

  • Abnormal Bleeding
  • Pelvic Pain
  • Endometriosis
  • Adenomyosis
  • Uterine Fibroids
  • Cancer of the Uterus, Ovaries or Cervix
  • Prolapse of the Uterus

Abdominal Hysterectomy

The first type of hysterectomy performed was an Abdominal Hysterectomy.  In this surgery, a six inch incision is made low in the abdomen and the uterus is removed. This incision goes from the skin through the connective tissues into the abdomen. Due to it’s large size and depth, recovery is longer and more painful. Today, fewer abdominal hysterectomies are performed as gynecologists are now trained in newer technologies allowing less invasive procedures. For example in 1997 at one medical center, 95% of hysterectomies were performed abdominally, today less than 30% are performed abdominally.

Total Laparoscopic Hysterectomy

In a Total Laparoscopic Hysterectomy (TLH) small incisions are made in the abdomen through which instruments are inserted to remove the uterus. One of these instruments is a pencil-like operating telescope called a laparoscope, which allows the surgeon to visualize the inside of the abdomen. The major benefits of this kind of minimally invasive hysterectomy are:

  • Less pain
  • Quicker recovery and return to normal activities
  • Shorter surgery time and lower cost when compared to a robotic hysterectomy
  • The ability to visualize the ovaries and other abdominal contents and treat any abnormalities
  • One night hospital stay or less
  • Minimal blood loss
  • Less risk of complications

What about the Da Vinci or Robotic Hysterectomy?

The Da Vinci Hysterectomy is another form of minimally invasive hysterectomy. In this surgery there are more incisions and they are larger than in a TLH described above. Through these incisions instruments are placed in the patient’s abdomen that are connected to a mechanical robot. The physician then sits at a console apart from the patient and moves the instruments with the aid of the robot instead of directly with his or her hands.

Since it’s approval by the FDA in 2005, the company that makes the Da Vinci robot has heavily advertised directly to patients. Most medical device companies market directly to doctors. Doctors can then decide whether this product is appropriate for their patients. The marketing for the DaVinci Hysterectomy implies that this type of hysterectomy is superior to all other types. However this only holds true when it is compared to the more invasive abdominal hysterectomy and not when it is compared to the total laparoscopic hysterectomy.

An article in the January 2014 issue of Obstetrics and Gynecology states:

“… the potential advantages of robotic assistance in laparoscopy, while initially appealing, have not been borne out by research and clinical reports. Among those are three dimensional visualization, tremor reduction, and ‘more precise’ dissection, none of which have been demonstrated to translate to clinical benefit for the patient. Postoperative pain is not better in the robotically operated patient and has been reported as worse in some studies.”

In a paper published in The Journal of the American Medical Association, researchers compared outcomes in 264,758 women who had either laparoscopic or robotically assisted hysterectomy at 441 hospitals between the years of 2007 and 2010.

The researchers found no overall difference in complication rates between these two groups, and no difference in the rates of blood transfusion – even though one of the claims regarding robotic surgery is that it causes less blood loss.

But the researchers did find a very big difference in cost. The Da Vinci robot assisted hysterectomy costs on average one-third more than laparoscopic hysterectomy! (Who is going to pay for all that marketing?)

As physicians our role is to educate our patients and perform procedures that have proven benefits. With the increased costs and decreased availability of healthcare for everyone in today’s economy, it is not responsible to promote the use of medical devices without proven benefits and that only increase costs.


At Women’s Healthwise we understand that choosing a hysterectomy as the best treatment option for you can be an overwhelming decision. We will carefully evaluate your needs and consult with you to determine the best course of treatment for you.

At Women’s Healthwise, we believe in caring for the whole patient and includes our patient’s financial well being as well as their physical well being.