How is a hysterectomy performed?

A hysterectomy can be performed as an open procedure, through the vaginal canal, or as a minimally invasive laparoscopic procedure. It is done in a hospital or surgical center.

A laparoscopic hysterectomy uses very small incisions instead of the large incision made in open surgery. Laparoscopic surgery generally entails a faster recovery time and less pain than open surgery.

Surgical approaches to a hysterectomy

A hysterectomy may be performed using one of the following approaches:

  • Abdominal hysterectomy (open hysterectomy) is the removal of the uterus through a five-to-seven-inch incision in the lower part of your belly. The incision may be vertical or horizontal. A horizontal incision (bikini cut) is placed very low on the abdomen so it is not easily visible.
  • Vaginal hysterectomy is the removal of the uterus through an incision made in the vagina. The incision is then closed with stitches until it heals.
  • Laparoscopic hysterectomy is the removal of the uterus through several small incisions in your abdomen. A small tube fitted with a special camera and other surgical instruments are inserted through the small incisions to remove the uterus.
  • Laparoscopically assisted vaginal hysterectomy (LAVH) is a vaginal hysterectomy that uses a laparoscopic camera to help your doctor see the uterus and surrounding tissues.
  • Robot-assisted laparoscopic hysterectomy is similar to a laparoscopic hysterectomy but includes a surgeon-controlled robotic device attached to surgical instruments and a laparoscopic camera.

Your doctor will determine which type of hysterectomy is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different hysterectomy procedures and ask why your doctor will use a particular type of procedure for you.

Types of anesthesia that may be used

Hysterectomies are performed using either general anesthesia or a nerve block.

  • General anesthesia is generally a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control your pain during and after surgery.
  • Regional anesthesia is also known as a nerve block. Regional anesthesia involves injecting an anesthetic around the nerves in the spine that transmit pain signals from the surgical area. This temporarily eliminates all pain during surgery. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your hysterectomy

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent.
  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. Your care team will give you blankets for modesty and warmth.
  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
  • A surgical team member will start an IV.
  • The anesthesiologist or nurse anesthetist will start your anesthesia.
  • A tube will be placed in your windpipe to protect and control your breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
  • A team member will insert a urinary catheter into your bladder to collect urine.
  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout surgery and recovery until you are alert, breathing effectively, and your vital signs are stable.