Advertisement

How is a hysterectomy performed?

The traditional hysterectomy removes the uterus only. In this video, Renee Cotter, MD, of West Hills Hospital, explains why and how the procedure is done for women.

Hysterectomy, or removal of the uterus, can be performed through the vagina (vaginal hysterectomy), abdominally (through a traditional abdominal incision), laparoscopically (small incisions) or with robot-assisted laparoscopy.  Hysterectomy can also be performed by combining the above procedures such as laparoscopic-assisted vaginal hysterectomy in which part of the procedure is performed using the laparoscope then completed vaginally. Hysterectomies including the vaginal, laparoscopic or robot-assisted approaches are considered minimally invasive surgeries and are associated with reduced hospital stays and quicker return to normal activities.

The choice of hysterectomy should be individualized to each patient; factors include the type of gynecologic pathology present and if any additional procedures are required. In consultation with the patient, the procedure with the lowest risk of complication and the best outcome is chosen for each individual situation.

There are essentially three ways of performing a hysterectomy: abdominally, vaginally and laparoscopically.

  • An abdominal hysterectomy is performed through a horizontal or vertical incision in the abdominal wall. Common reasons for this type of hysterectomy include large fibroids, a history of severe scar tissue, such as seen with previous cesarean section and uterine cancer. Although sometimes necessary, this type of hysterectomy is the most invasive of the three options and is therefore the least preferred. Women undergoing an abdominal hysterectomy should expect to stay in the hospital for about three days.
  • In a vaginal hysterectomy, the uterus is removed through a surgical incision in the vagina, leaving no visible scar. This approach has the fewest complications and is considered the safest type of hysterectomy. It is also associated with the shortest hospital stay (one day), the quickest return to normal activities and the least amount of pain.
  • With a laparoscopic hysterectomy, a small incision is made in the belly button and a lighted instrument is used to display the internal organs on a high definition screen. Typically, two additional small incisions are made in the lower abdomen and thin surgical instruments are used by the surgeon to perform the surgery. There are several different ways to perform a laparoscopic hysterectomy, all of which are associated with less pain and a shorter hospital stay than the abdominal hysterectomy.
Dr. Kevin W. Windom, MD
OBGYN (Obstetrician & Gynecologist)

A hysterectomy can be performed in numerous ways. The most common way of performing a hysterectomy is a total abdominal hysterectomy in which a patient has a bikini incision made on her abdomen, and the cervix and uterus are removed through this incision. Seventy-five percent of hysterectomies done in the United States are performed in this manner. A patient can expect 5-6 weeks of recovery time due to the large abdominal incision.

Hysterectomies can also be performed through a vaginal approach in which instruments are placed in the vagina and the cervix and uterus are detached through incisions in the vagina. This has a much easier recovery than a total abdominal hysterectomy, but patients can have severe amounts of vaginal pain. Sometimes the uterus is too big and there can be problems with the surgery being performed in this manner. Some doctors prefer to perform hysterectomies in which part of it is done laparoscopically with 3 or 4 small incisions on the abdomen and then part of it vaginally. This is a good procedure if the uterus is slightly bigger because the top part of the uterus can be detached laparoscopically and the rest of the procedure can be performed through the vagina. This surgery has a 3-4-week recovery time and is a very popular surgery done in the United States.

The newest way to perform a hysterectomy is a total laparoscopic hysterectomy in which the uterus and cervix are removed laparoscopically with 3 small incisions on the abdomen or they can be removed robotically with 5 small incisions on the abdomen. A robotic hysterectomy and a laparoscopic hysterectomy are the same procedure, it is just some doctors do not feel comfortable performing the hysterectomy with instruments in their own hands and want to use the robot for assistance. This procedure has a 2-week recovery time and is becoming very popular.

Another form of this procedure would be a supracervical hysterectomy in which the cervix is left in place or a single-incision laparoscopic hysterectomy in which the entire hysterectomy is done with 1 incision in the umbilicus. Personally, I prefer a total laparoscopic hysterectomy or a single-incision laparoscopic hysterectomy. The downtime is 1-2 weeks and the cosmetic effect is superior to the other procedures. The patient is able to have good vaginal support after support after the procedure and is less likely to have pelvic organ prolapse.

There are different ways that your doctor can perform a hysterectomy. It will depend on your health history and the reason for your surgery.

Abdominal hysterectomy. This is done through a 5- to 7-inch incision, or cut, in the lower part of your belly. The cut may go either up and down, or across your belly, just above your pubic hair. Vaginal hysterectomy. This is done through a cut in the vagina. The doctor will take your uterus out through this incision and close it with stitches.

Laparoscopic hysterectomy. A laparoscope is an instrument with a thin, lighted tube and small camera that allows your doctor to see your pelvic organs. Your doctor will make three to four small cuts in your belly and insert the laparoscope and other instruments. He or she will cut your uterus into smaller pieces and remove them through the incisions. Laparoscopically assisted vaginal hysterectomy (LAVH). Your doctor will remove your uterus through the vagina. The laparoscope is used to guide the procedure. Robotic surgery. Your doctor uses a special machine to perform the surgery like laparoscopic surgery. It is most often done when a patient has cancer or is very overweight and vaginal surgery is not safe.

This answer is based on source information from the National Women's Health Information Center.

Hysterectomy and other gynecologic surgeries are done in several different ways:

  • Abdominal hysterectomy (laparotomy): this is “open” surgery, in which the surgeon reaches the uterus through an incision (cut) in the skin and tissue of the lower abdomen. The incision is usually about 5 inches long, similar to a C-section incision.
  • Vaginal hysterectomy: this is surgery done through an incision in the vagina. The surgeon passes instruments though this incision and removes the uterus through the vagina. Sometimes the surgeon will combine transvaginal surgery with laparoscopy, so that an image of the site and procedure shows on a screen to guide the surgeon. This is called laparoscopic-assisted vaginal hysterectomy, or LAVH.
  • Laparoscopic hysterectomy (laparoscopy): this is surgery done through small incisions in the abdomen. The surgeon is guided by a tiny lighted camera (a laparoscope) passed through an incision. If you are having a robotic-assisted hysterectomy, a machine translates the surgeon’s hand movements into small, precise maneuvers.

Continue Learning about Gynecology

Can Your OB-GYN Provide Primary Care?
Can Your OB-GYN Provide Primary Care?
For straight-up down-there medical problems—a yeast infection, say, or a positive at-home pregnancy test—there’s no question you should call on your o...
Read More
How do I prepare for a Pap smear test?
Sky Ridge Medical CenterSky Ridge Medical Center
No preparation is needed for a Pap smear. However, we do recommend that you are not on your period w...
More Answers
8 Hysterectomy Myths to Stop Believing
8 Hysterectomy Myths to Stop Believing8 Hysterectomy Myths to Stop Believing8 Hysterectomy Myths to Stop Believing8 Hysterectomy Myths to Stop Believing
From recovery time to your post-surgery sex life, we’re debunking some of the common misconceptions.
Start Slideshow
What Is a Single-Site Robotic Hysterectomy?
What Is a Single-Site Robotic Hysterectomy?

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.