Catherine Spader, RN
What is a hysterectomy?
A hysterectomy is the surgical removal of a woman’s uterus to treat a variety of diseases, disorders and conditions of the uterus and reproductive system. The uterus is a pear-shaped organ located in the lower abdominal (pelvic) area where a baby grows during pregnancy.
Uterus removal is a common but major surgery with significant risks and potential complications. Removing the uterus also means you will no longer be able to bear children. Your body may experience other changes as well, including early menopause if both of your ovaries are removed. You may have less invasive treatment options depending on your condition and specific circumstance, so consider getting a second opinion about your treatment options before having a hysterectomy.
Types of hysterectomy
The types of hysterectomy procedures include:
Supracervical hysterectomy (subtotal or partial hysterectomy) is removal of part of the uterus, leaving the cervix intact.
Total hysterectomy is removal of both the uterus and the cervix.
Radical hysterectomy is an extensive surgery that includes removal of the uterus, the top of the vagina, and tissues around the cervix. Your doctor may perform a radical hysterectomy if you have cancer.
Other surgical procedures that may be performed
Your doctor may perform other procedures in addition to a hysterectomy. These include:
Oophorectomy is the removal of one or both ovaries, which are glands that produce a woman’s eggs and female hormones. Ovary removal may be necessary for certain conditions, such as cancer.
Salpingectomy is the removal of one or both fallopian tubes, which connect the ovaries to the uterus.
Why is a hysterectomy performed?
Your doctor may recommend a hysterectomy to treat a variety of diseases and conditions of the uterus and reproductive system. A hysterectomy may only be considered if other treatment options that involve less risk and fewer complications have been ineffective in treating your condition.
Ask your doctor about all of your treatment options to understand which option is best for you. Consider getting a second opinion, especially if you still want to bear children or have not yet reached menopause.
Your doctor may recommend a hysterectomy for:
Abnormal vaginal bleeding that does not get better with other treatments, such as medication or procedures that do not involve removal of the uterus
Adenomyosis, a thickening of the uterus that causes heavy, painful periods. Adenomyosis may be treated in some cases without a hysterectomy with medications and may go away on its own after menopause.
Cancer of the cervix, ovaries or uterus (often endometrial cancer). Certain cases of cervical cancer or precancerous changes of the cervix may be treated without removing the uterus.
Childbirth complications, such as uncontrolled bleeding or uterine rupture (rare)
Chronic pelvic pain that does not improve with other treatments
Endometriosis, an abnormal uterine tissue growth that causes severe menstrual pain, chronic low back and pelvic pain, and abnormal vaginal bleeding. Endometriosis can often be treated without a hysterectomy with medications or a minimally invasive laparoscopic procedure to remove the endometrial lesions.
Uterine fibroids, which are benign tumors of the uterus that can cause significant bleeding and pain. Fibroids often need no treatment or may be treated without a hysterectomy with medications or less invasive procedures, such as uterine artery embolization myomectomy.
Uterine prolapse, which is when the uterus drops or slides into the vagina. Uterine prolapse is often treated with a hysterectomy. Other treatment options include a vaginal device (pessary) that holds the uterus in place, and a surgical procedure that uses ligaments to support the uterus.
Who performs a hysterectomy?
The following specialists perform hysterectomies:
Obstetrician-gynecologists specialize in women’s reproductive health and pregnancy.
Gynecologic oncologists specialize in diagnosing, treating and preventing cancer of the female reproductive system.
General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions.
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 w