Hysterectomy Procedures

If you’ve recently been diagnosed with a health condition that requires the removal of your uterus (hysterectomy), you may now be searching for information about the different types of procedures. You should discuss the various options with your doctor. Ultimately, your surgeon will determine the type of hysterectomy you’ll need, based on the specific circumstances of your condition. The four types of hysterectomy procedures are:

• Partial or supracervical hysterectomy.The cervix (lower end of the uterus) is left intact and only the upper part of the uterus is removed. Since the cervix is still there, there is a risk of cervical cancer, and regular pap screenings will still be required.
• Complete or total hysterectomy.This is the most common type of procedure, and involves the entire removal of the uterus, including the cervix.
• Total hysterectomy and bilateral salpingo-oophorectomy.This is a total hysterectomy, plus the removal of the ovaries and fallopian tubes. As a result, the patient will go through what is known as surgical menopause. Ask your doctor about the best way to treat the symptoms of menopause.
• Radical hysterectomy.The removal of the cervix, the uterus, the upper part of the vagina, and supporting tissues, including the lymph nodes (usually performed when cervical cancer is involved).

If your doctor has recommended a hysterectomy, it’s important to get as much information about the procedure. How it’s performed may provide certain advantages in the speed and ease of your recovery. For example, here are two methods for a hysterectomy:

• During a traditional “open” surgery, a large incision is made to the abdomen in order to view the internal organs and remove the uterus.
• With minimally invasive procedures, also called laparoscopic hysterectomies, surgeons use specialized tools inserted through smaller incisions. This approach typically results in less pain and scarring after the operation and may lead to a faster recovery.

Hysterectomy Procedures

More than 550,000 hysterectomies are performed each year in the U.S.²¹ Of those, about 260,000 are done using minimally invasive procedures, where only small incisions are required.²¹

The most commonly performed procedure is a total abdominal hysterectomy (TAH). This is a traditional “open” procedure, where a five-inch incision is made into the abdominal wall. Through this opening, the surgeon removes the uterus, including the cervix. There is a hospital stay of three to five days. Recovery time will usually take about six weeks, leaving a visible scar.

Some conditions require a total abdominal hysterectomy and only your surgeon can recommend which procedure is best for you. If your doctor determines that you are a candidate for a minimally invasive hysterectomy (using small incisions), you may experience a shorter hospital stay, faster recovery, and less pain and scarring than you would if you have a total abdominal hysterectomy.

The first type of minimally invasive method involves what is known as a vaginal hysterectomy. An incision is made at the top of the vagina, through which the uterus, including the cervix, is separated from surrounding tissue and then taken out through the vagina. This small vaginal incision heals quickly, and usually won’t leave an external scar. There is little discomfort since the abdominal muscles are not stretched during the procedure. It takes one to two hours and requires a hospital stay of about one to three days. The recovery time will usually take about four weeks.

This procedure can be performed using advanced minimally invasive techniques, where a laparoscope (a miniature camera) is used to view of the uterus. The surgeon uses specialized instruments, inserted through small ¾-inch incisions, to detach the uterus, which is then removed through the vagina. This is known as a laparoscopically assisted vaginal hysterectomy.

The second type of minimally invasive procedure is called a laparoscopic supracervical hysterectomy. Here, the surgeon uses laparoscopic tools, inserted through small ¾-inch incisions, to separate the uterus from the cervix. The uterus is then removed through one of the small abdominal incisions. In this surgery, the cervix remains, which means routine pap smears are necessary to detect for cervical cancer. The procedure usually takes one to two hours and a hospital stay of one to three days is usually required. The recovery time will usually take about four weeks.

Site References

Talking to Your Surgeon about Hysterectomy Surgery

If your doctor has recommended that you a have a hysterectomy, it can be overwhelming. So it is important to feel comfortable enough to ask any questions you have. You should get as much information as you can to help you understand the reasons why your uterus needs to be removed and all the possible outcomes. Here are some questions for you to get the conversation started.

• Are there different types of hysterectomies?
• How long will it take me to recover from having a hysterectomy?
• When will I be able to leave the hospital?
• Will my ovaries or any reproductive organs other than my uterus be removed?
• When can I resume my normal activities, including school, work, exercise, sexual activity, and recreation?
• What type of hysterectomy will I have? Is it a total abdominal hysterectomy or a minimally invasive procedure?
• Is there a type of minimally invasive procedure appropriate for my situation?
• Exactly where, and how big, will the incisions be that are made on my body to perform the surgery?
• I'd like to make sure I am having the least-invasive procedure. Is that possible?