What Is Involved in a Hysterectomy?

A hysterectomy involves the surgical removal of a woman's uterus, or womb, as treatment for certain specific medical conditions. There are two kinds of hysterectomies: partial, or supracervical, which includes removal of the uterine body but not the cervical stump; and total, or complete, which consists of removing the entire uterus. All hysterectomies leave the patient unable to bear children.

Purpose

• Hysterectomies are performed in response to a few specific medical conditions, including cancer or tumors, extreme postpartum bleeding or extreme growth of the uterine lining outside the uterine cavity. Hysterectomies also sometimes are performed as a precautionary measure, such as on women who have a strong family history of reproductive cancers.

Abdominal Technique

• There are three main ways a hysterectomy can be performed: abdominal, laparoscopic and vaginal. Abdominal is the oldest technique; it involves making an incision through the abdominal wall, usually above the pubic bone. This process, which is usually done during total hysterectomies, gives doctors the greatest access to the reproductive organs. Recovery usually takes four to six weeks, but it can take longer.

Laparoscopic Technique

• A total laparoscopic hysterectomy is performed through a laparoscope (a flexible fiberoptic instrument equipped with biopsy forceps, an obturator, scissors or other devices) which is placed in the abdomen, starting at the top of the uterus. During the process, the entire uterus is disconnected from its attachments using long, thin instruments; then all tissue to be removed is passed through the small abdominal incisions made by the laparoscope. A supracervical laparoscopic hysterectomy is like total laparoscopic surgery, with the difference being the uterus is amputated instead of entirely removed.

Vaginal Technique

• Vaginal hysterectomy is performed entirely through the vaginal canal, and it has several advantages over abdominal surgery, including fewer complications, shorter hospital stays and shorter healing time. Vaginal hysterectomy is also the only technique that can be performed without total anaesthesia or on an outpatient basis. It's either not possible or very difficult, however, to perform complicated hysterectomies using the vaginal technique.

Risks

• Although hysterectomies can be life-saving, they also have risks and side effects, including premature menopause due to estrogen levels dropping when the ovaries are removed. Removing the uterus and ovaries also raises the risk of cardiovascular disease. In addition, a decrease in bone density and increased risk of bone fractures are associated with hysterectomies, and some women develop ovarian cysts after a hysterectomy.