Hysterectomy Surgery
A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:
Uterine fibroids that cause pain, bleeding, or other problems
Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
Cancer of the uterus, cervix, or ovaries
Endometriosis
Abnormal vaginal bleeding
Chronic pelvic pain
Adenomyosis, or a thickening of the uterus
Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.
Types of Hysterectomy
Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. Patients and health care providers sometimes use these terms inexactly, so it is important to clarify if the cervix and/or ovaries are removed:
In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping the cervix in place.
A total hysterectomy removes the whole uterus and cervix.
In a radical hysterectomy, a surgeon removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present.
The ovaries may also be removed -- a procedure called oophorectomy -- or may be left in place. When the tubes are removed that procedure is called salpingectomy. So, when the entire uterus, both tubes, and both ovaries are removed, the entire procedure is called a hysterectomy and bilateral salpingectomy-oophorectomy.
Surgical Techniques for Hysterectomy
Surgeons use different approaches for hysterectomy, depending on the surgeon’s experience, the reason for the hysterectomy, and a woman's overall health. The hysterectomy technique will partly determine healing time and the kind of scar, if any, that remains after the operation.
There are two approaches to surgery - a traditional or open surgery and surgery using a minimally invasive procedure or MIP.
Open Surgery Hysterectomy
An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting for about 54% for all benign disease.
To perform an abdominal hysterectomy, a surgeon makes a 5- to 7-inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision.
Following an abdominal hysterectomy, a woman will usually spend 2-3 days in the hospital. There is also, after healing, a visible scar at the location of the incision.
Abdominal hysterectomy. Most women go home 2-3 days after this surgery, but complete recovery takes from six to eight weeks. During this time, you need to rest at home. You should not be doing housework until you talk with your doctor about restrictions. There should be no lifting for the first two weeks. Walking is encouraged, but not heavy lifting. After 6 weeks, you can get back to your regular activities, including having sex.
Vaginal or laparoscopic assisted vaginal hysterectomy (LAVH). A vaginal hysterectomy is less surgically invasive than an abdominal procedure, and recovery can be as short as two weeks. Most women come home the same day or the next. Walking is encouraged, but not heavy lifting. You will need to abstain from sex for at least 6 weeks.
Laparoscopic supracervical hysterectomy (LSH). This procedure is the least invasive and can have a recovery period as short as six days to two weeks. Walking is encouraged, but not heavy lifting.
