Total Abdominal Hysterectomy (TAH)

A total abdominal hysterectomy (TAH) removes the entire uterus, both the body and the cervix, through an open abdominal incision. The word "total" separates it from a supracervical (subtotal) hysterectomy, where the cervix is left in place, and "abdominal" separates it from the vaginal, laparoscopic and robotic routes. TAH is done for fibroids, abnormal bleeding, endometriosis, adenomyosis, pelvic infection, chronic pelvic pain, prolapse and gynecologic cancers. It is often combined with removal of both tubes and ovaries (TAH-BSO), and repairs for vaginal prolapse can be done at the same time. Minimally invasive routes are preferred when they are possible, so today the open operation is used mainly for a very large uterus, heavy scarring or adhesions in the pelvis, complex disease or suspected cancer that needs wide access. The incision is usually a low transverse Pfannenstiel. A vertical midline or paramedian incision is used when more room is needed or the upper abdomen must be explored. For the scrub, a TAH has a steady rhythm: clamp, clamp, cut and tie, repeated on each side, using heavy hysterectomy clamps (Heaney, Heaney-Ballantine, Ochsner) and stick ties on a Heaney needle holder. When the vagina is opened, the case becomes clean-contaminated. Instruments that touch the cervix or vagina are kept apart, and three closing counts are done: at the vaginal cuff, the peritoneum and the skin. The main risks are bleeding, injury to the ureters, bladder or bowel, infection and blood clots.