Hysterectomy is the surgical removal of the uterus or womb. It is the second most common operation for women after cesarean section delivery. Approximately 600,000 hysterectomies are performed in the United States every year.
Reasons for a hysterectomy include:
- Uterine fibroids or growths that cause bleeding or pain
- Cancer of cervix, uterus and ovaries
- Endometriosis that can’t be controlled with medication
- Abnormal vaginal bleeding
- Adenomyosis (uterine thickening)
- Uterine prolapse
Types of Hysterectomy
There are three types of hysterectomies:
- Partial hysterectomy: The upper portion of the uterus is removed but the cervix is left inside
- Total hysterectomy: The entire uterus with cervix is removed; the 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
There are three approaches to a hysterectomy which are dependent upon the size of the uterus, history of surgery, uterine mobility, the skill of the surgeon, and the reason for 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. It requires the longest hospitalization (3-7 days) and longest recovery (6-8 weeks).
- Provides the largest opening for enlarged uterus or tumors
- Best exposure for cancer surgery and viewing adjacent organs
- Increased risk of hernia in the future
Vaginal: The cervix and uterus are removed through the vagina. This procedure is usually reserved for uterine prolapse, where the uterus is coming down the birth canal and is visible or felt through the labia. It is 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 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, and the cervix is often left in place for future support. It is generally not used in patients with endometriosis, fibroid tumors or cancer.
- The ability to maintain a higher level of sexual arousal
- Decreased risk of future pelvic floor prolapse
- Faster recovery
- Smaller scar than total abdominal hysterectomy
- Possibility of increased blood loss
- Possible damage to adjacent organs
A hybrid approach to hysterectomy is the Laparoscopic Assisted Abdominal Hysterectomy (LAVH). A laparoscopic procedure is performed, 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.