Types of Hysterectomy

What is a Hysterectomy?

A hysterectomy is the surgical removal of the uterus. The uterus is a muscular, pear-shaped organ that is part of the female reproductive system. Sometimes, your doctor will also recommend removing the cervix, which connects the uterus to the vagina. Your doctor may also recommend removal of the ovaries where eggs are formed, and the fallopian tubes which the eggs travel through to get to the uterus during a woman's child bearing years.

What are your options?

Hysterectomy Procedures Comparison Chart

There are four different ways to perform a hysterectomy:

• Abdominal (also known as Open) - An abdominal hysterectomy typically requires a 6 to 8 inch horizontal or vertical incision below the belly button to remove the uterus and cervix and, in some cases, other organs.  This is the most invasive kind of hysterectomy and is performed under general anesthesia, generally requires 5-6 days stay in the hospital, and up to 6 weeks of recovery time.
  
  
• Vaginal - A vaginal hysterectomy uses a smaller incision inside the vagina to remove the uterus and other organs, as determined by your doctor. The incision is not visible externally. Vaginal hysterectomies usually require a 1-3 day hospital stay and up to 4 weeks' recovery time.
  
  
• Laparoscopic - A laparoscopic hysterectomy utilizes a thin, lighted telescope-like instrument called a laparoscope along with small surgical instruments to perform the procedure.  The instruments are inserted through 3 to 5 tiny (5-10mm) incisions in the navel and abdomen to detach and remove the uterus. There are different types of laparoscopic hysterectomies. Based upon your clinical need, your doctor might perform a laparoscopic supracervical hysterectomy (LSH), allowing you to keep your cervix, or a total laparoscopic hysterectomy (TLH), which removes both the uterus and cervix.  There is a third type of laparoscopic hysterectomy called laparo-endoscopic single site (LESS) surgery which allows the surgeon to perform the entire procedure through one single, 15-25mm, incision in the belly button.  (Click on LSH, TLH, or LESS to see an animation of the procedure)
  
  
• Laparoscopic-Assisted Vaginal Hysterectomy - A laparoscopic-assisted vaginal hysterectomy is a combination procedure that incorporates both a laparoscopic and vaginal approach. The procedure begins with 3 to 5 tiny incisions in the navel and abdomen and is completed through incisions inside the vagina to remove the uterus and cervix.

Maintaining the Cervix

LSH leaves the cervix intact whereas in a TLH procedure the cervix is removed. Some surgeons believe that leaving the cervix intact may reduce the risk of urinary incontinence and pelvic support problems, as well as increase sexual stimulation. Because the cervix is left intact, women who have this procedure will still need to have yearly pap smears. Not all women are candidates for the LSH procedure. It is best to talk with your doctor about your options.

Removal of Ovaries

Depending on your medical diagnosis, your ovaries may not be removed.  The removal of your ovaries may lead to symptoms associated with menopause, including hot flashes, insomnia, irritability, or vaginal dryness.  These symptoms may be reduced by alternative therapies.  Ask your doctor about your options.

Less Invasive Options

Unlike your mother's hysterectomy, you now have several different procedure options when it comes to your decision to have surgery.  Today's hysterectomy choices include LESS, LSH, and TLH which are innovative, minimally-invasive procedures that can be modified by your doctor to address the treatment and relief of your symptoms.  These new advanced surgical techniques reduce the pain and minimize the scarring from surgery, typically require only one day in the hospital, and generally get you back to your normal routine within a few weeks. 

Benefits of Laparoscopic Hysterectomy [1] 

• Less Time in the Hospital - Laparoscopic hysterectomies require less time in the hospital compared to abdominal hysterectomy.  Most patients can expect to go home the same day as surgery or within 24 hours, whereas abdominal hysterectomies usually require 5-6 days in the hospital.
  
  
• Quicker Recovery - With laparoscopic hysterectomy, many patients return to normal activity within a few weeks.  Abdominal hysterectomy patients can expect up to 6 weeks or more of recovery.
  
  
• Less Pain & Scarring - Laparoscopic hysterectomy procedures only require a few small incisions, which means less postoperative pain compared to abdominal hysterectomy.  The smaller incisions also result in less scarring on the abdomen. 
  

Risks & Complications

Before making your decision to have surgery, it is important to understand the risks. There is always a probability that your laparoscopic hysterectomy may be converted to an open procedure if there are unforeseen complications during your procedure such as difficult anatomy or excessive bleeding. While major risks are rare, all surgery should be considered carefully. With laparoscopic surgery, as with all surgery, there are the typical risks of reactions to medications or problems resulting from the anesthesia, bleeding, infection, problems breathing, blood clots in the veins or lungs, inadvertent injury to other organs or blood vessels near the uterus, and even death, which is rare. The risk for serious complications depends on the reason the surgery is needed and your medical condition and age, as well as on the experience of the surgeon and anesthesiologist. Ask your doctor what you should expect after surgery, as well as the risks that may occur with surgery.

Alternatives to Hysterectomy

If you determine that you are not ready for surgery, you may have other options. If your periods are very heavy or last a long time, your doctor may prescribe hormone replacement therapy. Medication does not work for all women but is an option for some. Another alternative to surgery is endometrial ablation, which can be performed in the office. Endometrial ablation is a medical procedure that removes the lining of the uterus, called the endometrium. After endometrial ablation, you may no longer have any bleeding, but a percentage of women do continue to experience lighter menstrual cycles.

Know Your Options

Your doctor or surgeon will help you determine what treatment is best for you. Some factors that your doctor will consider before surgery are obesity, history of prior surgery, and any underlying medical conditions. Review a list of suggested questions to help guide you through your discussion with your health care provider.

Ask questions. Seek a second opinion. Make an informed choice.