Hysterectomy FAQ, Part 2

In our Hysterectomy FAQ Part 1, we addressed common concerns about hysterectomy. Here we will provide more information about the procedure.

What are the different ways a hysterectomy can be performed?

The routes of hysterectomy include:

  • Vaginal
  • Abdominal
  • Laparoscopic
  • Robotic
  • Laparoscopic assisted vaginal hysterectomy (LAVH)

Each type of hysterectomy allows the surgeon to take out the uterus, and also the fallopian tubes and ovaries if needed and desired by the patient. They also allow for other procedures to be done as needed.

What is a vaginal hysterectomy and what are its advantages?

This type of hysterectomy is performed entirely through the vagina. The incision is in the vagina and there are no incisions on the abdomen.

The main advantages of this procedure are:

  • quick recovery
  • short or no hospital stay
  • rapid return to normal activity
  • less pain
  • no scars on the abdomen

This is the least invasive type of hysterectomy. It is beneficial for all patients, but the uterus cannot be too big or too scarred to be able to be removed through the vagina.  It is not appropriate for people with cancer. It may be the best option for persons with multiple medical conditions who may be at higher risk for complications. It may also be the best option for the elderly or those who cannot tolerate extended periods of anesthesia. It can be combined with other vaginal surgeries for prolapse and urinary incontinence if appropriate.

What is an abdominal hysterectomy and what are its advantages?

In this procedure, the uterus is removed through a single large incision on the abdomen. This is the most invasive type of hysterectomy. It generally is done for persons with very large fibroids and for gynecologic cancers.

Due to its invasive nature, patients are normally in the hospital for two or more nights, are slower to return to regular activity and generally experience more pain.

What are laparoscopic and robotic hysterectomies and what are the advantages?

In this surgery, the surgeon makes 4-6 small incisions on the abdomen and uses laparoscopic instruments or a robot to do the hysterectomy.  These types of hysterectomies are considered minimally invasive. As such, patients recover faster. They may go home the day of surgery or stay overnight and generally have less pain compared to an abdominal hysterectomy.

The robotic hysterectomy has gained popularity in recent years and the percentage of robotic hysterectomies continues to increase nationwide. Currently the robot is used to perform the hysterectomy in many cases of cancer.

What is a laparoscopic assisted vaginal hysterectomy (LAVH) and what are the advantages?

This is a combination of both the laparoscopic and vaginal routes. Part of the procedure is done laparoscopically through the abdominal wall. The rest of the procedure is completed through the vagina. This route allows evaluation of the abdomen and pelvis during surgery. It may help decrease the complexity of surgery, especially in women with adhesions, ovarian cysts, endometriosis or previous surgery.  In this surgery the patient has incisions both on the abdomen as well as in the vagina.

What determines the type of hysterectomy I get?

Choice of procedure is in large part determined by:

  • reason for hysterectomy
  • existing pathology
  • surgeon training and skill
  • need for additional procedures
  • available resources and equipment in the hospital

While the overall trend is towards minimally invasive routes and shortened hospital stays, your surgeon will discuss your options as well as make recommendations. Shared decision making is important.

What are the risks of hysterectomy?

Like all surgeries, there is risk of:

  • bleeding
  • infection
  • injury to blood vessels or nerves
  • injury to neighboring organs
  • blood clots
  • stroke
  • heart attack
  • death

Your surgical and anesthesia teams work before, during and after surgery to decrease the occurrence of these risks as much as possible.

Take Home Points

  • There are different types of hysterectomy, and each has its own benefits and disadvantages. These types include:
    • Vaginal
    • Abdominal
    • Laparoscopic
    • Robotic
    • Laparoscopic assisted vaginal hysterectomy (LAVH)
  • Minimally-invasive procedures are generally preferred. There are many important factors to consider when determining the best type of hysterectomy. Making careful informed decisions with your surgeon is important.

Author Information

Roseanne Gichuru, DO, MBA obtained her undergraduate degrees in Cellular Molecular Biology & Women’s Studies from West Chester University.  She obtained her Medical Degree from Philadelphia College of Osteopathic Medicine and her MBA from St. Joseph University.  She completed her OB/GYN residency at Crozer Chester Medical Center.  She currently practices in PA. She has no disclosures to report.

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