I’m glad you asked! Does TVH stand for Total Vaginal Hysterectomy or Transvaginal Hysterectomy? Seems like a simple enough question. There are a few different ways of answering this question. Both can be found in some books and literature today.
Maybe the most straightforward way of answering this is to see what the American Board of Obstetrics and Gynecology (ABOG) says. In the instructions for the Oral Exam, they list these approved abbreviations:
Well that seems to be enough for me. But lets keep looking:
- TeLinde’s Gynecology (Chapter 3) says Total Vaginal Hysterectomy.
- Most textbooks, in fact, say either Total Vaginal Hysterectomy or they just say Vaginal Hysterectomy and avoid the abbreviation altogether. This is the case for William’s Gynecology, Bonney’s, Baggish and Karram, and several other modern texts. None of the major, modern texts use the term transvaginal hysterectomy.
- A Google Books search for “total vaginal hysterectomy” reveals 1730 hits, whereas for “transvaginal hysterectomy” only 362. A deeper look reveals that most occurrences of transvaginal hysterectomy are in non-gynecologic texts or foreign texts.
- How about older books? The term “total vaginal hysterectomy” dates back to at least 1924. A chapter in Operative Surgery by Bickham is entitled “Total Vaginal Hysterectomy.” Only one use of the term “transvaginal hysterectomy” appears in a Google Books search before 1990, and this was in a Scottish publication.
- A Pubmed search reveals the term “total vaginal hysterectomy” dating back to 1951. “Transvaginal hysterectomy” finds its earliest reference in English language publications in 1987.
Another way of thinking about it is by analogy or parallel usage. If TAH stands for “total abdominal hysterectomy” and TLH stands for “total laparoscopic hysterectomy,” then it stands to reason that TVH stands for “total vaginal hysterectomy.” The T in all instances could stand for trans-, but it is unnecessary and redundant. We could just as easily remove the trans- from each and one would still understand what is meant by abdominal, vaginal, or laparoscopic hysterectomy. But the T does add some information: it implies that the entire corpus of the uterus and cervix was removed as opposed to a subtotal hysterectomy or supracervical hysterectomy.
But there in lies the rub…
Isn’t it silly to say total vaginal hysterectomy, as if there were also subtotal vaginal hysterectomies? But that’s just it … there are subtotal vaginal hysterectomies. Its actually not that hard to do in many cases.
Dougal Bissel advanced the idea of the subtotal vaginal hysterectomy in the United States in 1917, building on the work of Doderlein from the previous decade. For a short while, the subtotal vaginal hysterectomy had some popularity, preserving the uterosacral ligaments and the cervix which was thought then to have some benefits. So the term Total Vaginal Hysterectomy was created in the 1920s to describe the total procedure, as opposed to the subtotal or Doderlein procedure as it is often referred to today.
How do you do it? Make only an anterior colpotomy and flip the fundus of the uterus around through the colpotomy, taking the upper pedicles and then amputating the corpus from the cervix. Then close the anterior colpotomy. Not a difficult task for a parous woman with a normal-sized uterus but completely unnecessary as we understand it today.