Hysterectomy Overview – Patient Education
A hysterectomy, which is the second most common operation for women after cesarean section delivery, involves removal of the uterus or womb. This is distinct from whether or not the ovaries are removed. Approximately 600,000 hysterectomies are performed annually in the United States. Read more in this patient education guide.
Indications for a hysterectomy include:
- Symptomatic uterine fibroids/growths (bleeding, pain, pressure)
- Cancer of cervix, uterus, and ovaries
- Endometriosis (uncontrolled by medication)
- Abnormal vaginal bleeding
- Adenomyosis (uterine thickening)
- Uterine prolapse
There are three types of hysterectomies:
Partial hysterectomy: the upper portion of the uterus is removed but the cervix is left inside (also known as subtotal or supracervical)
Total hysterectomy: the entire uterus with cervix is removed (most common type)
Radical hysterectomy: the entire uterus with cervix is removed, along with the upper part of the vagina and adjacent tissue (usually done for treatment of uterine cancer)
*Removal of the ovaries and tubes along with the uterus is called “hysterectomy with bilateral salpingo- oophorectomy” (TAHBSO) and is often performed together.
There are three approaches to a hysterectomy which are dependent upon the size of the uterus, history of prior surgery, uterine mobility, the skill of the surgeon, as well as the pathological indication of the surgery. The approaches are:
Abdominal: an incision is made through the abdomen (either up and down from the navel to the pubic bone) or horizontally, just above the pubic bone; requires the longest hospitalization (3-7 days) and longest recovery (6-8 weeks)
- Provides the largest opening for enlarged uterus/tumors
- Best exposure for cancer surgery and viewing adjacent organs
- Increased future possibility for incisional hernia
Vaginal: cervix and uterus are removed through the vagina; usually reserved for uterine prolapse (where the uterus is coming down the birth canal and is visible or felt through the labia); not recommended if there is an enlarged uterus (with fibroids), scar tissue from prior surgery or endometriosis, or lack of uterine descent or mobility
- Less invasive
- Less costly
- Recovery time is shortened.
- Possible damage to bladder, bowel and ureters
Laparoscopic: air inflates the abdomen for improved visibility and a lit telescope like instrument (laparoscope) attached to a video camera is inserted through the belly button so that the procedure can be viewed on a monitor; the uterus is removed with additional instruments which are inserted through two or three additional small incisions; cervix is often left in place for future support; contradictions include endometriosis, fibroid tumors, and cancer.
- The ability to maintaining a higher level of sexual arousal
- Decreased risk of future pelvic floor prolapse
- Faster recovery
- Smaller scar than total abdominal hysterectomy
- Increased exposure to anesthesia
- Possibility of increased blood loss
- Possible damage to adjacent organs
A hybrid approach to hysterectomy is the Laparoscopic Assisted Abdominal Hysterectomy (LAVH). Here, a laparoscopic procedure is performed, the organs are well visualized and appropriate incisions are made, but the uterus is removed vaginally instead of abdominally. The benefits of this procedure are a lower risk of damage to surrounding structures than with a vaginal hysterectomy and good visualization, which is not obtained through a vaginal hysterectomy alone.