There are various different forms of hysterectomy, as well as different approaches to performing these surgeries.
The type of procedure chosen depends on the patient’s condition and how much of their womb and surrounding structures needs to be removed and how much the surgeon is trying to leave in place.
The main types of hysterectomy include:
- Total hysterectomy – Here, both the womb and the cervix are removed. This is the most common form of hysterectomy.
- Subtotal hysterectomy – This surgery involves removal of the main body of the womb, but leaves the cervix in place.
- Total hysterectomy with bilateral salpingo-oophorectomy – In this procedure, the womb, cervix, fallopian tubes and ovaries are all removed.
- Radical hysterectomy – This surgery involves removing the womb, cervix, fallopian tubes and ovaries, as well as part of the vagina, the fatty tissue and the lymph glands.
The different approaches to performing a hysterectomy are described below.
For the abdominal hysterectomy, a transverse incision is made through the abdominal wall, above the pubic bone. The incision is around the size of that made for a caesarean section. This technique allows excellent access to the reproductive structures and is usually the chosen procedure when the entire reproductive system is due to be removed. An abdominal hysterectomy can take 4 to 6 weeks to recover from because the wound made in the abdominal wall can take this long to heal.
In vaginal hysterectomy, the entire procedure is performed through the vaginal canal and the uterus is removed through an incision made in the upper end of the passage. This offers obvious advantages over the open surgery procedure described above such as fewer associated risks and complications, lower infection rate, shorter hospital stay and shorter healing time.
A laparoscopic-assisted vaginal hysterectomy is an approach which involves making small incisions in the abdomen, through which laparoscopic instruments can be inserted to view the internal organs. This is also referred to as key-hole surgery or minimally invasive surgery, due to the small incision size, low risk of operative injury and faster post-operative recovery compared with the abdominal procedure.
Laparoscopic-assisted vaginal hysterectomy also enables surgeons to perform more detailed exploration and more complicated surgeries than the vaginal hysterectomy does. The procedure begins with laparoscopic processes and ends with the removal of the uterus via the vaginal canal. A more recent approach is laparoscopic-assisted supracervical hysterectomy (LASH), which uses a morcellator to cut the uterus into fragments that can then be removed through laparoscopic ports made in the abdomen. This enables the uterus to be removed from the body, without having to also remove the cervix.
Reviewed by Sally Robertson, BSc